Form Wc 240 Georgia – Fill Out and Use This PDF

The WC-240 form is a critical document in the Georgia workers' compensation system, used by employers to inform employees of an offer of employment that is deemed suitable given the employee's condition, in compliance with O.C.G.A. 34-9-240 and Board Rule 240. This notification, including all necessary attachments, must be delivered to the employee and their counsel at least ten days before the expected return to work date. For guidance on how to properly fill out and submit the WC-240 form, click the button below.

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Form Wc 240 Georgia PDF Details

In the realm of workplace injuries, navigating the road to recovery while ensuring financial stability can be fraught with challenges. Central to this process in Georgia is the Form WC-240, a document that plays a critical role in the transition back to work for employees who have suffered work-related injuries. Mandated by the Georgia State Board of Workers' Compensation, the WC-240 or "Notice to Employee of Offer of Suitable Employment", is utilized by employers to communicate a job offer to an injured employee that accommodates their medical restrictions as per O.C.G.A. 34-9-240 and Board Rule 240. The form not only outlines the specifics of the job offer, including the position, duties, pay rate, and work schedule, but also serves as a notice that should the employee decline the offer without just cause, they risk suspension of their income benefits. Moreover, this document, which must be accompanied by reports from the treating physician approving the job as suitable, establishes a safety net: if the employee attempts the job but is unable to continue for fifteen days, their income benefits are reinstated. Essential to ensuring a fair process, the WC-240 must be furnished to the employee, and if applicable, their counsel, at least ten days before they are expected to resume work, demonstrating the procedural and protective measures embedded in Georgia's approach to workers' compensation and return-to-work practices.

Question	Answer
Form Name	Form Wc 240 Georgia
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	approving, CERTIFICATION, WC-240, pursuant

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WC-240 NOTICE TO EMPLOYEE OF OFFER OF SUITABLE EMPLOYMENT

GEORGIA STATE BOARD OF WORKERS' COMPENSATION

NOTICE TO EMPLOYEE OF OFFER OF SUITABLE EMPLOYMENT

Instructions: The employer shall use this form to notify an employee of an offer of employment which is suitable to his/her impaired condition, as required by O.C.G.A. 34-9-240 and Board Rule 240. This form, with all attachments, must be provided to the employee and counsel for the employee at least ten days prior to the date the employee is expected to return to work. This form, along with attachments, should only be filed with the Board as an attachment to a Form WC-2.

Board Claim No.

Employee Last Name

Employee First Name

M.I.

SSN or Board Tracking #

Date of Injury

A. IDENTIFYING INFORMATION

	County of Injury	Address
EMPLOYEE

Employee E-mail		City	State	Zip Code

	Name	Address
EMPLOYER

Employer E-mail		City	State	Zip Code

B. NOTICE TO EMPLOYEE

This is to inform you that the following job is being made available to you pursuant to the requirements of O.C.G.A. 34-9-240 and Board Rule

240 (b):

Title

Essential Duties (Attach Additional Pages as needed)

Rate of Pay	Location of Job

Hours / Days to be Worked	Date / Time to Report for Work

2.A copy of the report(s) of your authorized treating physician(s), approving the job as suitable to your condition, is / are attached.

If you unjustifiably refuse to attempt to performs the job offered after receiving this notification, the employer / insurer shall be authorized to suspend payment of income benefits to you effective the date you are scheduled to report to work. Should you attempt but fail to continue

3.working for fifteen (15) scheduled work days, your income benefits shall immediately be reinstated.

If you have any questions about the job being offered to you, you may contact the employer at:

C. CERTIFICATION

I hereby certify that the above-named job is available to this employee as outlined above, that the job duties have been approved by the authorized treating physician(s) who has examined the employee within 60 days of the attached approval, and that this offer is being made in good faith no later than ten days prior to the date the employee is expected to report for work. I further certify that I have this day sent a copy of this form to the employee and counsel for employer (if represented.)

Print Name / Title Here

E-mail

Address

Signature

Date

City

State

Zip Code

IF YOU HAVE QUESTIONS PLEASE CONTACT THE STATE BOARD OF WORKERS’ COMPENSATION AT 404-656-3818 OR 1-800-533-0682 OR VISIT http://www.sbwc.georgia.gov

WILLFULLY MAKING A FALSE STATEMENT FOR THE PURPOSE OF OBTAINING OR DENYING BENEFITS IS A CRIME SUBJECT TO PENALTIES OF UP TO $10,000.00 PER VIOLATION (O.C.G.A. 34-9-18 AND 34-9-19).

WC-240	REVISION . 07/2011	240	NOTICE TO EMPLOYEE OF
			OFFER OF SUITABLE EMPLOYMENT

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Form Wc 240 Georgia – Fill Out and Use This PDF

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