GA WC-14 2011 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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GA WC-14 Form Versions

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GA WC-14 2018

4.8 Satisfied (56 Votes)

GA WC-14 2011

4.4 Satisfied (439 Votes)

How to fill out GA WC-14

01

Begin by downloading the GA WC-14 form from the official Georgia Department of Labor website.

02

Fill in your personal information, including your name, address, and contact details in the designated fields.

03

Provide your social security number where indicated.

04

Select the appropriate reason for filing the claim from the options provided.

05

Fill out the section regarding your employment history, including employer names, dates of employment, and any relevant details.

06

Review the instructions for any supporting documentation required and attach it as necessary.

07

Double-check all entered information for accuracy.

08

Submit the completed form via mail or online, as directed.

Who needs GA WC-14?

01

Individuals who have recently been laid off or experienced a reduction in hours due to no fault of their own.

02

Workers seeking unemployment benefits in Georgia.

03

Anyone who is filing a claim for unemployment insurance.

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What is GA WC-14?

GA WC-14 is a form used in Georgia for reporting workers' compensation claims and insurance information.

Who is required to file GA WC-14?

Employers in Georgia who have workers' compensation insurance must file GA WC-14 when they have an employee injury or illness.

How to fill out GA WC-14?

To fill out GA WC-14, you need to provide details about the injured employee, the nature of the injury, the circumstances of the incident, and insurance information.

What is the purpose of GA WC-14?

The purpose of GA WC-14 is to formally document and report workplace injuries to ensure compliance with state regulations regarding workers' compensation.

What information must be reported on GA WC-14?

Information required on GA WC-14 includes employee details, injury specifics, employer information, and insurance provider details.

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