Get Ga Wc-25 2007-2026

The GA WC-25 form is an application for lump sum or advance payment that must be completed accurately to ensure proper processing by the Georgia State Board of Workers' Compensation. This guide provides clear, step-by-step instructions on how to fill out the form online, making the process smooth for users with varying levels of experience.

Follow the steps to complete the GA WC-25 form online.

1. Click the 'Get Form' button to access the GA WC-25 form and open it in an online editor.
2. Fill in the identifying information section. This includes your employee last name, first name, middle initial, social security number, date of injury, county of injury, and your current address including city, state, and zip code.
3. In the statement of monthly expenses and income section, list all monthly expenses such as house rent or mortgage, groceries, clothing, child care expenses, medical and dental expenses not related to workers' compensation, school expenses, and utilities. Ensure you specify any past due amounts next to each category.
4. Under income, summarize all sources of income including worker’s compensation benefits, social security payments, income from spouse, and other family members living with you.
5. Document any loans and debts by listing the date of the loan, the name of the creditor, and the balance owed.
6. Total your monthly expenses and income to provide an overview of your financial situation.
7. Attach required documents such as a current medical report detailing your physical status and supporting documentation for past due bills.
8. In the affidavit section, indicate if you have received weekly income benefits for 26 weeks or more and specify your request for either a lump sum payment or an advance payment. Include necessary details on how these funds will be utilized.
9. Finish by signing the form where indicated and prepare it for submission. Ensure you include the signature of a notary public if required.
10. Finally, save any changes made to the form, download it, or print it out for your records before submitting it to the necessary parties.

Fill out the GA WC-25 form online today to ensure timely processing of your benefits.