Get Ga Wc-102d 2018

The GA WC-102D form is essential for filing a motion or objection to a motion with the Georgia State Board of Workers' Compensation. This guide will walk you through the process of completing the form online, ensuring you provide all necessary information accurately.

Follow the steps to fill out the GA WC-102D online.

1. Use the 'Get Form' button to retrieve the GA WC-102D form and open it in your preferred editor.
2. In the 'Board Claim No.' field, insert the specific claim number associated with your case. This is crucial for proper identification of your motion or objection.
3. Fill out the 'Employee' section with the employee's last name, first name, mailing address, city, state, and zip code. Also, provide their claims email and phone number for further communication.
4. Complete the 'Insurer/Self-Insurer' section with the name, mailing address, phone number, and claims office details of the insurance provider or self-insurer involved in the claim.
5. In the 'Attorney for Employer/Insurer' section, if applicable, include the attorney's name, mailing address, GA Bar number, email, and phone number.
6. Fill in the 'Date of Injury' field and the 'County of Injury' field, as these are critical elements for the claim.
7. Under the 'Action Requested' section, indicate whether you are filing a motion or an objection by selecting the appropriate checkbox and specify the purpose. Attach any supporting arguments and documentation as needed.
8. Complete the 'Entry of Appearance' section by certifying the existence of a valid fee contract or asserting any good faith attempts made to reach an agreement concerning the issue.
9. Sign the form in the 'Certificate of Service' area by printing your name, providing your phone number, and entering your email address and date. This certifies that copies of the form have been sent to the necessary parties.
10. Once you have filled out all sections of the form, review for accuracy. Save your changes, then download, print, or share the completed form as needed.

Complete your GA WC-102D form online today to ensure your motion or objection is filed correctly.