Georgia Workers’ Compensation Adjuster Reference Chart, Produced by AI

📘 Legal Framework

🧾 Claims Handling Guidelines

🧑‍⚖️ Licensing & Ethics

📌 Compliance Tips

• Always use latest Board forms from SBWC website 
• Maintain accurate wage data for benefit calculations
• Ensure timely communication with claimants and legal counsel

🔑 Key Claims Handling Rules for Georgia Workers' Compensation Adjusters

📝 Initial Claim Processing

• Form WC-1: Must be filed within 21 days of employer's knowledge of injury, disability, or death.
• Sections A–D: Completed by employer and insurer; includes injury details, wage data, and insurer info.
• Late Filing Penalty: Failure to file WC-1 on time may result in penalties under Board Rule 221(d).

💵 Wage & Benefit Documentation

• Form WC-6: Required for wage statements and benefit calculations.
• Methods of Computation: Must follow Board guidelines for fractional weeks and average weekly wage.

⚰️ Death Claims

• Forms WC-1 & WC-2a: Used to report and manage death benefits.
• Beneficiaries & Guardians: Must be documented and verified.

🔄 Subsequent Claim Processing

• Form WC-2: Used to initiate, suspend, or change income benefits.
• Form WC-3: Required for benefit changes (e.g., TTD to TPD).
• Permanent Partial Disability: Requires WC-2, WC-6, and medical documentation.

📊 Case Progress & Reporting

• Form WC-4: Tracks ongoing claim status and must be updated regularly.
• Form WC-26: Annual report of medical-only cases and indemnity payments.

💻 Electronic Data Interchange (EDI)

• EDI Filing: Mandatory for insurers and TPAs.
• Compliance Monitoring: SBWC tracks timeliness and accuracy of electronic submissions.

💰 Lump Sum & Advance Payments

• Form WC-25: Required for lump sum payment applications.
• Board Approval: All lump sum settlements must be reviewed and approved.

🏥 Medical Benefits

• Authorized Treatment: Must comply with Board Rule 203(a).
• Disputes: Handled under Rules 203(b) and 205.
• Pre-Authorization: Required for certain treatments.
• Medical Reports: Must be submitted promptly and accurately.

🧑‍⚖️ Legal & Compliance Notes

• Use of Current Forms: Always use the latest Board-approved versions.
• SBWC ID Number: Mandatory on all filings.
• Servicing Agent Changes: Must be reported via Form WC-121.

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