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First Benefits Insurance Mutual Claims

Claims Department Phone: 800.360.7867
Fax: 919.977.5844

Official Notice Required

Georgia law requires an employer to post an Official Notice in a conspicuous place that is readily accessible to employees at all times. Click here to download the Official Notice. (Enter your information once the form is downloaded.) The Official Notice must include the name, address and phone number for six physicians who are available to treat injured workers.

The list must include:

  • an orthopaedic surgeon,
  • a minority physician (defined as a group which has been subjected to prejudice based on race, color, sex, handicap or national origin), and
  • four additional qualified physicians.
  • The list may not include more than two physicians from industrial clinics.

The Official Notice is also required to include the name, address and phone number of your workers’ compensation insurance carrier.

Panel of Physicians Form

In addition to the Official Notice, we strongly recommend that employers in Georgia have a prepared form that lists the six required panel physicians reflected on the Official Notice. Click here to download the Panel of Physicians Form. (Enter your information once the form is downloaded.) The form should include the name of each physician and the physician’s address and phone number. We strongly encourage employers to have an injured worker complete this or a similar form at the time of injury.

If you need assistance preparing a list of six panel physicians, please contact the Claims Department at First Benefits and we will be happy to assist you.

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