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Get Ga Wc-200a 2007
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How to fill out the GA WC-200a online
The GA WC-200a form is used for requesting a change of physician or additional treatment by consent in Georgia workers' compensation cases. This guide provides a step-by-step approach to filling out the form accurately and efficiently online.
Follow the steps to complete the GA WC-200a form online.
- Press the ‘Get Form’ button to obtain the GA WC-200a form and open it in your preferred online editor.
- Begin by filling out the identifying information section. Include the board claim number, employee's last name, first name, middle initial, social security number, and date of injury. Ensure the county of injury, address, email address, and city, state, and zip code are filled out accurately.
- In the physicians/treatment section, list the currently authorized treating physician's name and address. Next to the section indicating the physician's name, provide the city, state, and zip code. Then, indicate the physician you are requesting authorization for by filling out their name, city, state, and address.
- Clearly state the additional treatment that has been authorized. This section should reflect the specifics of the additional medical care being needed.
- Proceed to the agreement section. Here, specify the changes regarding the treating physician and confirm that the employer will cover necessary and reasonable medical expenses. Be sure to include the effective date of the changes.
- Have the employee or their representative sign the agreement, along with the employer or their representative. Fill in their addresses, cities, email addresses, and GA Bar numbers if applicable.
- In the certification section, certify that copies have been sent to all relevant parties and the State Board of Workers’ Compensation. Include the signature, email, date, and phone number.
- Review all completed information for accuracy. Once confirmed, you can save the changes, download, print, or share the form as needed.
Complete your GA WC-200a form online today for a seamless filing process.
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To obtain a workers' comp exemption in Georgia, you need to complete and submit the appropriate application, typically found on the GA WC-200a form. Ensure you meet the eligibility criteria, which may include being a sole proprietor or a member of certain professions. After submission, monitor your application status and seek assistance from uslegalforms if you encounter any issues.
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