Get the free WC-R1 - sbwc georgia

WC-R1 REQUEST FOR REHABILITATION GEORGIA STATE BOARD OF WORKERS COMPENSATION REQUEST FOR REHABILITATION Board Claim No. Employee Last Name Employee First Name SECTION 1 Occupation M.I. SSN or Board

How to fill out wc-r1 - sbwc georgia

How to fill out wc-r1 - sbwc Georgia:

1. Begin by downloading the wc-r1 form from the State Board of Workers' Compensation (SBWC) website in Georgia.
2. Fill in the date of injury or illness in the provided space. Make sure to include the month, day, and year accurately.
3. Enter the injured worker's full name, address, and contact information. Include any relevant details like their social security number or employee ID.
4. Provide the name and address of the employer where the injury or illness occurred. Include their workers' compensation insurance carrier's name and policy number if available.
5. Specify the injured worker's occupation or job title at the time of the incident.
6. Describe the nature of the injury or illness in detail, including the body part affected and the circumstances surrounding the incident.
7. Indicate whether the injury resulted in death or requires medical treatment. If medical treatment is necessary, provide information about the healthcare provider or hospital involved.
8. If the injured worker had previous injuries or pre-existing conditions, mention them. Also, mention any prior workers' compensation claims they have made.
9. Sign and date the form. If you are completing the form on behalf of the injured worker, include your name and relationship to the worker.
10. Submit the completed wc-r1 form to the SBWC or as directed by your employer or insurance carrier.

Who needs wc-r1 - sbwc Georgia?

1. Injured workers in Georgia who experience a work-related injury or illness and wish to file a workers' compensation claim. This form is necessary to document the incident and initiate the claims process.
2. Employers in Georgia are also required to have knowledge of the wc-r1 form as they need to report any injuries or illnesses that occur in the workplace to the State Board of Workers' Compensation. This form helps employers fulfill their legal obligations and ensure proper documentation of workplace incidents.
3. Insurance carriers operating in Georgia's workers' compensation system may use the wc-r1 form to process claims made by injured workers. Understanding this form is crucial for insurance professionals involved in claims management and processing.

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