GA WC-14 2018-2025 free printable template

WC-14 NOTICE OF CLAIM GEORGIA STATE BOARD OF WORKERS COMPENSATION Check only one NOTICE OF CLAIM ONLY REQUEST HEARING / NOTICE OF CLAIM REQUEST FOR MEDIATION / NOTICE OF CLAIM Complete a new Form WC-14 to add an additional employer insurer or to add date of injury. Sbwc.georgia.gov WILLFULLY MAKING A FALSE STATEMENT FOR THE PURPOSE OF OBTAINING OR DENYING BENEFITS IS A CRIME SUBJECT TO PENALTIES OF UP TO 10 000. 00 PER VIOLATION O. C. G.A. 34-9-18 AND 34-9-19. WC-14 REVISION. 07/2011 For...

How to fill out georgia workers compensation claim form

How to fill out GA WC-14

1. Obtain the GA WC-14 form from the state's website or your employer.
2. Fill in your personal information at the top, including your name, address, and Social Security number.
3. Indicate the date of your injury and the type of injury you sustained.
4. Provide details about your employer, including their name, address, and contact information.
5. Document the medical treatment you have received, including dates and names of healthcare providers.
6. List any time lost from work due to the injury and detail your job duties.
7. Sign and date the form to certify that the information provided is accurate.
8. Submit the completed form to your employer or the appropriate workers' compensation board.

Who needs GA WC-14?

1. Employees who have sustained a workplace injury and need to file a workers' compensation claim.
2. Employers who need to report incidents of workplace injuries to insurance providers.
3. Medical providers who need to document treatment provided to employees for work-related injuries.

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What is the correct way to write workers compensation?

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What is GA WC-14?

GA WC-14 is a form used in Georgia for reporting workplace injuries and illnesses for workers' compensation purposes.

Who is required to file GA WC-14?

Employers in Georgia who have employees that experience workplace injuries or illnesses are required to file GA WC-14.

How to fill out GA WC-14?

To fill out GA WC-14, employers must provide information about the injured employee, details of the incident, and any medical treatment provided.

What is the purpose of GA WC-14?

The purpose of GA WC-14 is to document and report workplace injuries for the purpose of workers' compensation claims and compliance with state regulations.

What information must be reported on GA WC-14?

The information that must be reported on GA WC-14 includes the employee's details, incident date and time, nature of the injury, and details of medical treatment received.