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GA WC-14 2018-2023 free printable template
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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...
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How to fill out georgia workers compensation claim

How to fill out Georgia workers compensation claim:
01
Obtain the necessary forms from the Georgia State Board of Workers’ Compensation or your employer.
02
Gather all relevant information, including your personal details, employer information, and the details of your injury or illness.
03
Provide a detailed description of how the injury or illness occurred, including the date, time, and location.
04
Include any medical records, reports, or documentation related to the injury or illness.
05
Describe the medical treatments you have received and any ongoing medical care required.
06
Explain how the injury or illness has impacted your ability to work and perform your job duties.
07
Sign and date the completed form, and make copies for your records.
08
Submit the completed claim form to the Georgia State Board of Workers’ Compensation or your employer.
Who needs Georgia workers compensation claim:
01
Employees who have suffered a work-related injury or illness in the state of Georgia.
02
Employees who require medical treatment or time off work due to a work-related injury or illness.
03
Employees whose ability to perform their job duties has been impacted by a work-related injury or illness.
04
Employers who are required by law to provide workers’ compensation benefits to their employees in Georgia.
05
Insurance companies or third-party administrators who handle workers’ compensation claims in Georgia.
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