Form Wc 240 Georgia – Fill Out and Use This PDF

Form Wc 240 Georgia is a vital document when it comes to the filing process of workers' compensation claims in the state. This form must be completed with accurate information and filed with the appropriate party, whether that's an employer or an insurance provider. The contents are critically important because they include relevant contact,claim and injury details needed for a successful workers' compensation claim. Because failure to provide accurate information or appropriately file this form could hamper or void a related claim, it's essential to understand what exactly is required before getting started. Understanding Form Wc 240 Georgia can help prevent mistakes that may delay the receipt of benefits or keep them from receiving the effective coverage they deserve for their workplace injuries.

Form Wc 240 Georgia PDF Details

In the state of Georgia, there are several different types of workers' compensation forms that employers and employees may be required to fill out. One such form is Wc 240. This form is used to report an employee's injury or illness, and must be completed within five days of the incident. It is important to understand the requirements for filling out this form correctly, in order to ensure that all necessary information is included. This blog post will provide a brief overview of the Wc 240 form, as well as instructions for completing it correctly.

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

How to Edit Form Wc 240 Georgia Online for Free

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Form Wc 240 Georgia – Fill Out and Use This PDF

Form Wc 240 Georgia PDF Details

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