Get Ga Wc-200b 2011
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How to fill out the GA WC-200b online
The GA WC-200b form is essential for requesting or objecting to a change of physician or additional treatment in workers' compensation claims in Georgia. This guide provides clear, step-by-step instructions for completing this form online, ensuring that all necessary information is submitted accurately and efficiently.
Follow the steps to successfully complete the GA WC-200b form online.
- Press the ‘Get Form’ button to obtain the GA WC-200b form and open it for editing.
- Fill in the Board Claim Number at the top to identify your specific claim.
- Enter the employee's last name, first name, and middle initial.
- Provide the date of injury and the employee's social security number or Board tracking number.
- In section A, enter identifying information such as the county of injury, name of counsel if represented, and the employee's address including city, state, and zip code.
- In section A, also provide the name, address, city, state, and zip code of the insurer or self-insurer.
- Under section B, indicate the name and address of the currently authorized treating physician.
- Specify whether you are requesting a change of physician or additional treatment in section B.
- In section C, state who is requesting the action (employee, employer, or insurer) and provide the name of the new treating physician if applicable.
- Detail the basis for the request or objection in section C, attaching any necessary supporting documentation.
- In section D, certify the existence of a valid fee contract or reference any previously filed forms.
- Complete the Certificate of Service in section E by certifying the effort to reach an agreement and providing your contact information, including signature and date.
- Once all fields have been filled out accurately, save your changes. Download, print, or share the completed form as necessary.
Complete your GA WC-200b form online today to ensure timely processing of your request.
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