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Georgia Form Center -

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Form

Description

wc001.pdf Employer's First Report of Injury
wc002.pdf Notice of Payment or Suspension of Benefits
wc002a.pdf Notice of Payment or Suspension of Death Benefits
wc003.pdf Notice to Controvert
wc004.pdf Case Progress Report
wc006.pdf Wage Statement
wc007.pdf Application for Self-Insurance* (Packet available through Licensure & Quality Assurance Division (404) 656-4893
wc010.pdf Notice of Election or Rejection of Workers' Compensation Coverage
wc011.pdf Standard Coverage Form Group Self-Insurance Fund Members
selfinsgov.pdf Application for Self-Insurance for Governmental Entities
wc012.pdf Request for Copy of Board Records
wc014.pdf Notice of Claim/Request for Hearing/Request for Mediation
wc014a.pdf Request to Change Information on a Previously Filed Form WC-14
wc015.pdf Attorney Affidavit for No-Liability Stipulations
wc020a.pdf Medical Report
wc025.pdf Application/Objection for Lump Sum/Advance Payment
wc026.pdf Consolidated Yearly Report of Medical Only Cases and Annual Payments on Indemnity Claims
wc100.pdf Request for Settlement Mediation
wc102.pdf Requests of Documents to Parties
wc102b.pdf Notice of Representation
wc102c.pdf Attorney Leave of Absence
wc102d.pdf Motion/Objection to Motion
wc104.pdf Notice to Employee of Medical Release to Return to Work with Restrictions or Limitations
wc108a.pdf Attorney Fee Approval
wc108b.pdf Attorney Withdrawal/Lien
wc121.pdf Notice of Use of Servicing Agent
wc131.pdf Permit to Write Insurance
wc131a.pdf Permit to Write Insurance Update
wc200a.pdf Change of Physician/Additional Treatment by Consent
wc200b.pdf Request/Objection for Change of Physician/Additional Treatment
wc205.pdf Request for Authorization of Treatment or Testing by Authorized Medical Provider
wc206.pdf Notice of Intent to Become a Party at Interest
wc207.pdf Authorization and Consent to Release Information
wc208.pdf Application for Certification of WC/MCO* (Packet available through Managed Care & Catastrophic Disability Division (404) 656-0849)
wc226a.pdf Petition for Appointment of Temporary Guardianship of Minor
wc226b.pdf Petition for Appointment of Temporary Guardianship of Legally Incapacitated Adult
wc240.pdf Notice to Employee of Offer of Suitable Employment
wc240a.pdf Job Analysis
wc243.pdf Credit/Reduction in Benefits
wc244.pdf Notice of Intent to Become a Party of Interest
wc262.pdf Wage Documentation of Temporary Partial Disability Payments
request_change.pdf Request to Change Information
change_of_address_ee.pdf Change of Address Form
change_of_address_er.pdf Change of Address Form
crr.pdf Catastrophic Rehab Release
r1.pdf Request for Rehabilitation
r1catee.pdf Request for Catastrophic Designation
r2.pdf Rehabilitation Transmittal Form
r2a.pdf Individualized Rehabilitation
r3.pdf Request for Rehabilitation Closure
r5.pdf Request for Rehab Conference
subpoena.pdf Subpoena (rev 1/17)
rehab_objection.pdf Rehab Objection
p1.pdf OFFICIAL NOTICE Panel of Physicians (Must be printed and posted on legal size (8.5 x 14) paper)
p1_sp.pdf OFFICIAL NOTICE Panel of Physicians (Must be printed and posted on legal size (8.5 x 14) paper (Spanish)
p3.pdf OFFICIAL NOTICE WC/MCO Panel Must be printed and posted on legal size (8.5 x 14) paper
p3_sp.pdf OFFICIAL NOTICE WC/MCO Panel Must be printed and posted on legal size (8.5 x 14) paper (Spanish)
rights.pdf POSTER - Bill of Rights (Must be printed and posted on legal size (8.5 x 14) paper)
rights_sp.pdf POSTER - Bill of Rights Spanish (Must be printed and posted on legal size (8.5 x 14) paper)
rehabsupplyapp.pdf Rehabilitation Supplier Application
rehabrenewapp.pdf Rehabilitation Renewal Application
StopWC_FraudPoster.pdf POSTER - Stop Workers Compensation Fraud Poster
StopWC_FraudPoster_Sp.pdf POSTER - Stop Workers Compensation Fraud Poster (Spanish)
reportfraud.pdf Workers' Compensation Fraud and Non-Compliance Reporting Form
proper_claim_reporting.pdf BROCHURE - Best Practices for Proper Claim Reporting
role_employer.pdf BROCHURE - Best Practices for Role of the Employer
selecting_doctors.pdf BROCHURE - Best Practices for Selecting Physicians for Your Panel
earlyreturn.pdf BROCHURE - Best Practices for Early Return to Work
communication.pdf BROCHURE - Best Practices for Communication with Workers Compensation System
employee_pamphlet.pdf BROCHURE - Questions & Answers About Georgia's Workers' Compensation Law
employer_pamphlet.pdf BROCHURE - How The Workers' Compensation Law Applies to Employers