Get Wc-108b Attorney Withdrawal / Lien Georgia State Board Of Workers'' Compensation Attorney

The WC-108b form is an essential document for attorneys wishing to withdraw from representing a client in a workers' compensation claim in Georgia. Filling it out accurately ensures compliance with legal requirements and facilitates a smooth transition.

Follow the steps to complete the form correctly

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the board claim number at the top of the form, followed by the employee's last name, first name, and middle initial. Include their social security number or board tracking number, along with the date of the injury.
3. In section A, notify the client by entering their name. Certify whether there is a pending review or scheduled hearing or mediation. If a hearing or mediation is scheduled, provide the date.
4. If applicable, indicate any deadlines by providing the specific date for the client’s response.
5. In section B, indicate whether you are waiving any claim for approval of attorney's fees and enter the date you formally withdrew from representation.
6. Certify the date you received written confirmation from your client regarding the termination of services and attach a copy of that communication.
7. State the fair and reasonable value of your services in the designated field. Attach any supporting documentation to substantiate the lien.
8. List any actual and reasonable expenses incurred related to this claim in the provided space.
9. In section C, certify the accuracy of the information by printing your name, including your contact details and signature.
10. Fill in your address, city, state, zip code, and GA bar number. Review the completed form for accuracy and completeness.
11. Once everything is filled out, save changes, and consider downloading or printing a copy for your records. Ensure you share a copy with all relevant parties.

Complete the WC-108b form online to facilitate your withdrawal process effectively.