Wc 102b 2026

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The document is a form titled 'Notice of Representation of Any Party Other Than a Claimant or Employee by an Attorney' issued by the Georgia State Board of Workers' Compensation. It serves to notify relevant parties that an attorney is representing a party involved in a workers' compensation case, excluding claimants or employees. The form requires identifying information about the employee, employer, and attorney, along with certification of notification to all parties involved.

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Click ‘Get Form’ to open the wc 102b in the editor.
Begin by filling in the Board Claim Number at the top of the form. This is essential for tracking your submission.
In the 'Identifying Information' section, enter the Employee's Last Name, First Name, Middle Initial, Date of Injury, and SSN or Board Tracking Number.
Complete the address fields for both the Employee and their Attorney. Ensure that all details are accurate to avoid processing delays.
Fill in information regarding the Employer and Insurer/Self-Insurer, including names and addresses. This helps clarify all parties involved.
In Section B, provide details about the Attorney representing a party, including their firm name and contact information.
Finally, sign and date the certification section to confirm that you have sent copies of this form to all relevant parties.

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