Get Ga Wc-102d 2021-2026

Filling out the GA WC-102D form correctly is essential for submitting a motion or objection to motion with the Georgia State Board of Workers' Compensation. This guide provides clear, step-by-step instructions to help you navigate the process easily.

Follow the steps to successfully complete the GA WC-102D online.

1. Press the ‘Get Form’ button to acquire the form and open it in the designated editing interface.
2. Begin by entering the Board Claim Number at the top of the form. This number is important for tracking your submission within the Board's system.
3. Fill out the employee section with the employee's first name, middle initial, last name, city, state, zip code, claims email, and phone number.
4. Provide the insurer or self-insurer's information, including their name and address, as well as the claims office’s SBWC ID number, city, state, and their contact details.
5. Complete the attorney for the employer or insurer section, including their name, mailing address, GA Bar number, email, and phone number.
6. In the attorney for the employee or claimant section, input the attorney's name, mailing address, GA Bar number, email, and phone number.
7. Next, enter the date of injury and county of injury in the A. Identifying Information section.
8. In section B. Action Requested, indicate whether you are submitting a motion or an objection, specifying the party’s role (employee, employer/insurer, or other party) and providing a description of the purpose of the motion or objection.
9. For section C. Entry of Appearance, certify the existence of a valid fee contract or attach Form WC-102B if applicable.
10. Complete section D. Certificate of Service by certifying that efforts have been made to resolve the issue, and document that the form has been sent to the State Board of Workers’ Compensation and all involved parties.
11. Finally, fill in your printed name, phone number, signature, email address, and date at the bottom of the form.
12. Once all sections are completed, remember to save your changes. You can also download, print, or share the form as needed.

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