Georgia workers compensation claim 2026

1. Click ‘Get Form’ to open the Georgia Workers Compensation Claim in our editor.
2. Begin by selecting the appropriate option at the top of the form: 'NOTICE OF CLAIM ONLY', 'REQUEST HEARING / NOTICE OF CLAIM', or 'REQUEST FOR MEDIATION / NOTICE OF CLAIM'.
3. Fill in your personal details under the EMPLOYEE section, including your last name, first name, birthdate, and mailing address.
4. In the INSURER/SELF-INSURER section, provide the insurer's name and mailing address. Ensure you include their SBWC number.
5. Complete the CLAIM INFORMATION section by detailing the date of injury, county of injury, and any relevant information about your claim such as part of body injured and description of accident.
6. If applicable, check any benefits you are requesting in the HEARING / MEDIATION ISSUES section and specify reasons for requests.
7. Finally, affirm that all information is correct by signing and dating at the bottom of the form before submitting it.

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