Get Notice Of Claim. Wc-014 - Sbwc Georgia

Filling out the NOTICE OF CLAIM, WC-014 - Sbwc Georgia, is an essential step for individuals seeking compensation for workplace injuries. This guide provides clear, step-by-step instructions to ensure that you complete the form accurately and effectively.

Follow the steps to complete your NOTICE OF CLAIM form online.

1. Click the ‘Get Form’ button to obtain the form and access it in your document editor.
2. Begin by filling in your personal information in the Employee section. Include your last name, first name, middle initial, social security number or board tracking number, date of injury, birthdate, and address.
3. Next, provide details about your employer. Include the name and address of the employer, the city, state, and zip code, along with the employer's email.
4. Fill in the Insurer/Self-Insurer information, including the insurer's name, address, city, state, zip code, and email.
5. In the Claim Information section, describe the part of the body that was injured, the first date you were disabled due to the injury, and if applicable, include the complete date of death for fatal claims.
6. Provide a detailed description of the accident that caused the injury. Be specific to ensure clarity.
7. If your claim involves issues related to hearing or mediation, check the corresponding boxes and fill out the required information regarding benefits and requests.
8. In the Affirmation section, verify the accuracy of your information by signing and dating the form.
9. Complete the Certificate of Service by certifying that you have sent a copy of the form to all parties involved.
10. Review all entered information for accuracy before saving your changes. You can then download, print, or share the completed form as necessary.

Complete your NOTICE OF CLAIM online today to ensure your rights are protected.