State of Georgia Forms in Word


Georgia Workers Comp Form No.

Georgia Workers Compensation Forms by Title


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WC-BOR Bill of Rights
(Revised 2007)

WC-BOR-Sp Bill of Rights (Espanol)
(Revised 2007)

WC-P1 Panel of Physicians $27.99

WC-P1Sp Panel of Physicians (Espanol) $27.99

WC-P2 Conformed Panel Of Physicians $27.99

WC-P2Sp Conformed Panel Of Physicians (Espanol) $27.99

WC-P3 WC/MCO Panel $27.99

WC-P3Sp WC/MCO Panel (Espanol) $27.99

WC-1 Employer’s First Report of Injury $27.99

WC-2 Notice of Payment or Suspension of Benefits $27.99

WC-2a Notice of Payment or Suspension of Death Benefits $27.99

WC-3 Notice to Controvert $27.99

WC-4 Case Progress Report $27.99

WC-6 Wage Statement $27.99

WC-10 Notice of Election or Rejection of Workers’ Compensation Coverage $27.99

WC-11 Standard Coverage Form Group Self-Insurance Fund Members $27.99

WC-12 Request for Copy of Board Records $27.99

WC-14 Notice of Claim/Request for Hearing/Request for Mediation $27.99

WC-14a Request to Change Employee Information on a WC-14 $27.99

WC-15 Attorney Certification for No-Liability Stipulations $27.99

WC-20a Medical Report $27.99

WC-25 Application for Lump Sum/Advance Payment $27.99

WC-26 Consolidated Yearly Report of Medical Only Cases/Indemnity Cases $27.99

WC-100 Request for Settlement Mediation $27.99

WC-102 Request for Documents to Parties $27.99

WC-102b Notice of Representation $27.99

WC-102c Attorney Leave of Absence $27.99

WC-102d Motion/Objection to Motion $27.99

WC-104 Notice to Employee of Medical Release to Return to Work with Restrictions or Limitations $27.99

WC-108a Attorney Fee Approval $27.99

WC-108b Attorney Withdrawal/Lien $27.99

WC-121 Notice of Change of TPA/Servicing Agent $27.99

WC-131 Application for Permit to Write Insurance $27.99

WC-131a Annual Insurance Update $27.99

WC-200a Change of Physician/Additional Treatment by Consent $27.99

WC-200b Request/Objection for Change of Physician/Additional Treatment $27.99

WC-205 Request for Authorization of Treatment or Testing by Authorized Medical Provider $27.99

WC-206 Notice of Intent to Become a Party at Interest $27.99

WC-207 Authorization and Consent to Release Information $27.99

WC-226a Petition for Appointment of Temporary Guardianship of Minor(s) $27.99

WC-226b Petition for Appointment of Temporary Guardianship of Legally Incapacitated Adult $27.99

WC-240 Notice to Employee of Offer of Suitable Employment $27.99

WC-240a Job Analysis $27.99

WC-243 Credit $27.99

WC-244 Notice of Intent to Become a Party at Interest $27.99

WC-262 Wage Documentation of Temporary Partial Disability Payments $27.99

WC-R1 Request for Rehabilitation $27.99

WC-R1CATEE Employee’s Request for Catastrophic Designation $27.99

WC-R2 Rehabilitation Transmittal Form $27.99

WC-R2a Individualized Rehabilitation Plan $27.99

WC-R3 Request for Rehabilitation Closure $27.99

WC-R5 Request for Rehab Conference $27.99

Rehab Objection Rehab Objection $27.99

Rehab Release Catastrophic Rehab Release $27.99

Change of Address Request for Change of Address $27.99

Subpoena Subpoena $27.99