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WC-200b REQUEST / OBJECTION FOR CHANGE OF PHYSICIAN / ADDITIONAL TREATMENT GEORGIA STATE BOARD OF WORKERS COMPENSATION REQUEST / OBJECTION FOR CHANGE OF PHYSICIAN / ADDITIONAL TREATMENT Instructions:
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How to fill out wc-200b - sbwc georgia
How to fill out WC-200B - SBWC Georgia:
01
Start by downloading the WC-200B form from the State Board of Workers' Compensation (SBWC) Georgia website. Make sure you have the appropriate version of the form.
02
Begin by filling out the top section of the form. Enter the date of the injury or death, as well as the name of the employee who sustained the injury.
03
Provide the employee's address, phone number, and Social Security number. If the injured employee is a minor, include their legal guardian's information.
04
In the "Employer's Information" section, enter the name, address, and contact information of the employer where the injury occurred. Include the employer's workers' compensation insurance information.
05
Proceed to the "Insurer/ Self-Insured Employer Information" section and fill in the name, address, and contact information of the workers' compensation insurer or self-insured employer.
06
In the "Medical Information" section, detail the names and addresses of any medical providers who have treated the injured employee. Include the dates of treatment and describe the nature of the injuries sustained.
07
If the injured employee had any pre-existing conditions that may affect their compensation claim, provide relevant details in the "Pre-existing Conditions" section.
08
Add the names and addresses of any witnesses who observed the injury or can provide valuable testimony.
09
Sign and date the form after completing it. The injured employee must also sign the form.
Who needs WC-200B - SBWC Georgia?
Employers, insurance carriers, or self-insured employers in the state of Georgia are required to complete and submit the WC-200B form. This form is used to report a workers' compensation claim and provide necessary information about the injury or death that occurred in the workplace. It ensures that the appropriate parties are notified and the injured employee receives the necessary benefits and medical treatment.
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What is wc-200b - sbwc georgia?
The WC-200B form is a wage verification form used by the State Board of Workers' Compensation in Georgia to verify an injured worker's earnings.
Who is required to file wc-200b - sbwc georgia?
Employers and insurance carriers are required to file the WC-200B form with the State Board of Workers' Compensation in Georgia.
How to fill out wc-200b - sbwc georgia?
The WC-200B form can be completed online or submitted via mail. It requires information such as the injured worker's name, social security number, and earnings.
What is the purpose of wc-200b - sbwc georgia?
The purpose of the WC-200B form is to verify an injured worker's earnings for the purpose of calculating workers' compensation benefits.
What information must be reported on wc-200b - sbwc georgia?
The WC-200B form requires information such as the injured worker's name, social security number, and earnings from the past 13 weeks.
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