Get 108a Form

The 108a form, officially known as the Attorney Fee Approval form, is essential for workers' compensation cases in Georgia. This guide provides a straightforward approach to completing the form online, ensuring you can efficiently manage your attorney fee requests.

Follow the steps to complete your 108a form online successfully.

1. Press the ‘Get Form’ button to access the 108a form and open it in your preferred editor.
2. Begin by filling out the identifying information in section A. Provide the board claim number, your last name, first name, middle initial, social security number, and date of injury. Ensure all contact details like county of injury, address, city, state, and zip code are accurately entered.
3. Move to section B to request approval of the attorney fee contract. Clearly indicate the percentage of the income benefits you are requesting, ensuring it does not exceed 25%. Include the total amount of income benefits and the frequency of payment, along with any additional supporting documentation.
4. In section C, request an assessment of the attorney's fee by consent. You will need to specify the reasonable value of services provided and any litigation expenses. Again, provide the necessary amounts and supporting documentation to bolster your request.
5. Complete section D by detailing the agreement of all parties related to the fee dispute. Specify which attorney should receive which fees and whether these should be lump sum payments or percentages based on income benefits.
6. Finally, fill out section E to certify your request. Sign and print your name, provide your date of signing, email, and Georgia bar number. Ensure that any additional parties' consent is documented at the bottom.
7. Once all sections are complete, save your changes. You can then download, print, and share the form as required.

Start your application process by completing the 108a form online today.