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Wc 14 form georgia 2026
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- Click ‘Get Form’ to open the WC-14 form in our editor.
- Begin by entering the Board Claim Number at the top of the form. This is essential for tracking your request.
- Fill in the Employee's Last Name, First Name, and Middle Initial. Ensure accuracy as this information is critical for identification.
- Input the Social Security Number and Date of Injury. Double-check these fields to avoid any errors that could delay processing.
- In Section A, indicate the changed information by selecting from options like Employee Name, Social Security Number, Date of Injury, or County of Injury. Clearly state what you are changing from and to.
- Provide reasons for the changes in the designated area to clarify your request.
- Complete Section B by certifying that you have sent a copy of this form to all relevant parties and include your printed name, address, signature, city, state, zip code, GA Bar number (if applicable), phone number, and date.
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Related links
Complete a new Form WC-14 to add an additional employer, insurer or to add date of injury. If you need additional space, do not alter this form, but insteadRead more
If you disagree with this denial, you must file a form WC-14, Notice of Claim, within one year of the accident with the State Board of Workers. CompensationRead more