Report an Injury Claim
- Complete form WC-1 – Employer’s First Report of Injury or Occupational Disease and fax to (888) 381-0924, email to firstname.lastname@example.org, call (800) 507-4622, or report a claim online using the link below. This should be done immediately upon knowledge of the injury. ALL claims should be reported, no matter how minor. If the claimant does not receive treatment, please mark the top of the First Report of Injury form “FOR REPORTING PURPOSES ONLY”. The claim will be processed for record only. Emergency Claims occurring after normal business hours may be reported by calling (404) 906-5641 or (678) 296-0411.
Click Here to Report a Claim Online
****USE INSURANCE ID # 30047 WHEN REPORTING A CLAIM ONLINE***
- Complete form WC-6 – Wage Statement and fax to 888/381-0924 or email to email@example.com. We must have 13 weeks gross income prior to the date of accident.
- Complete the Supervisor’s Report of a Claim and fax to 888/381-0924 or email to firstname.lastname@example.org. Please include as much detail as possible.
- Forward any medical records, bills or personal information that may affect the claim to:
AgriTrust of Georgia
c/o Georgia Administrative Services
1775 Spectrum Drive, Suite 100
Lawrenceville, GA 30043
- If the claim is suspicious, please contact the adjuster immediately at 800/507-4622. AgriTrust has 21 days from the date the injury is reported to accept or deny the claim.
- Offer the Panel of Physicians to the injured worker and have her/him select a physician for treatment. In the event of a serious injury which requires immediate care, the employee may seek treatment at the emergency room or walk-in clinic as long as they follow up with a panel physician.
- If the employee is not satisfied with their treating physician, they are entitled to a one time change from the Panel of Physicians. After the one time change from the Panel of Physicians, any further change must be by agreement of all parties.
- Medication can be filled at any pharmacy, as long as the adjuster is called for authorization.
- The adjuster should pre-approve all medical treatment such as tests, physical therapy, medications, referrals, etc.