Get Ga Wc-14a 2018-2025

Filling out the GA WC-14a form is an essential step for requesting changes to previously filed workers' compensation forms in Georgia. This guide provides a structured approach to assist you in accurately completing the form online.

Follow the steps to successfully complete the GA WC-14a online.

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. This number is crucial as it links your request to the previous filing.
3. Fill in the employee's information, including last name, first name, middle initial, birthdate, county of injury, mailing address, city, state, and zip code.
4. Next, complete the insurer or self-insurer section by providing the mailing address, city, state, and zip code for the claims office, along with the SBWC ID number and date of injury.
5. In the A. Claim Information section, include the employee's email address as well as the employer's name and mailing address in the designated fields.
6. Continue filling out the attorney's information for both the employee/claimant and the employer/insurer, providing their names, mailing addresses, Georgia Bar numbers, email addresses, cities, states, and zip codes.
7. Move to section B, Information to be amended. Clearly indicate the specific information you wish to amend by checking the appropriate box, such as the date of injury, employer’s name, dismissal of a party, or any additional hearing issues.
8. If amending the date of injury, you will need to specify both the original and the new dates within the form.
9. In section C, confirm your affirmation of filing by checking the corresponding box and providing the required print name, date, and contact information.
10. Complete section D for entry of appearance, indicating your compliance with the fee contract requirements if applicable.
11. Lastly, fill out section E, Certificate of Service, certifying that you have sent a copy of the form to all named parties and the State Board of Workers' Compensation.
12. Review the completed form for accuracy before saving changes, downloading, printing, or sharing the document as needed.

Prepare and submit your GA WC-14a online today to ensure your changes are processed efficiently.