Form WC-14: Georgia Notice of Claim

Form WC-14 PDF Details

For injuries on or after July 1, 2007, a claim for which neither medical nor income benefits have been paid shall stand dismissed if no hearing is held within five years of the alleged date of injury.

New employer or insurer: complete a new Form WC-14 to add an additional employer, insurer or to add date of injury.

Space: if you need additional space, do not alter this form, but instead attach additional sheets.

Ink: must be typed or printed in black ink.

Certificate of service: I hereby certify that I have today sent a copy of this form to all of the parties.