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Payment workers compensation 2026

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The document is a notice from the Georgia State Board of Workers' Compensation regarding the payment or suspension of death benefits for dependents of employees who have died due to work-related injuries. It outlines the benefits available, including medical expenses, funeral costs, and weekly wage compensation, as well as definitions of dependents and procedures for appealing benefit suspensions.

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Click ‘Get Form’ to open the payment workers compensation document in the editor.
Begin by entering the Deceased Employee's Social Security Number and their full name in Part B. Ensure accuracy as this information is crucial for processing.
Fill in the Date of Injury, Street Address, City, State, and Zip Code of the deceased employee. This helps establish the context of the claim.
In the Benefits section, specify the weekly benefit amount and average weekly wage. Make sure to include any penalties if applicable.
List all total dependents along with their addresses and dates of birth. If there are partial dependents, complete that section only if no total dependents exist.
Finally, review all entered information for accuracy before signing and dating the form. Remember to file the original with the State Board of Workers' Compensation.

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