⇨

Blank Wc 240 Georgia PDF Form

The WC-240 form is a critical document in Georgia's workers' compensation system, designed to notify employees of suitable job offers following an injury. This form ensures that employees are informed of available employment that aligns with their current health conditions, as mandated by state law. Understanding this form is essential for both employees and employers to navigate the return-to-work process effectively.

Ready to take the next step? Fill out the form by clicking the button below.

Content Overview

The WC-240 form, known as the Notice to Employee of Offer of Suitable Employment, plays a crucial role in the Georgia workers' compensation system. This document is designed to inform employees who have suffered injuries about job opportunities that match their current physical capabilities. It is essential for employers to complete this form accurately and provide it to the employee and their legal counsel at least ten days before the employee is expected to return to work. The WC-240 includes vital details such as the job title, essential duties, pay rate, job location, and the specific hours and days required. Additionally, it must be accompanied by reports from authorized treating physicians, confirming that the job is suitable for the employee's condition. If an employee refuses this job offer without justification, the employer may suspend income benefits. However, if the employee attempts the job and cannot continue for fifteen scheduled workdays, benefits can be reinstated. This form not only facilitates communication between employers and injured workers but also ensures compliance with state regulations, promoting a smoother transition back to work.

Document Preview

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

➤ PDF File

Form Specifications

Fact Name	Fact Description
Purpose	The WC-240 form is used by employers to notify employees of a job offer that is suitable for their impaired condition.
Governing Law	This form is governed by O.C.G.A. 34-9-240 and Board Rule 240.
Notification Requirement	Employers must provide this form to the employee and their counsel at least ten days before the expected return to work date.
Job Offer Details	The form requires essential details about the job, including title, duties, pay rate, location, and hours.
Physician Approval	A copy of the treating physician's report approving the job as suitable must be attached to the form.
Consequences of Refusal	If the employee unjustifiably refuses the job offer, the employer may suspend income benefits effective the scheduled report date.
Certification Requirement	The employer must certify that the job is available and that the offer is made in good faith, with required physician approvals.

Wc 240 Georgia: Usage Guidelines

Filling out the WC-240 form is essential for notifying an employee about a suitable job offer following an injury. This process ensures compliance with Georgia law and provides the necessary information to the employee regarding their return to work. Follow these steps carefully to complete the form accurately.

Obtain the WC-240 form from the Georgia State Board of Workers' Compensation website or your employer.
Fill in the Board Claim Number at the top of the form.
Provide the Employee's Last Name, First Name, and Middle Initial.
Enter the Social Security Number or Board Tracking Number.
Input the Date of Injury.
Complete the Identifying Information section with the County of Injury, Employee's Address, City, State, and Zip Code.
Fill in the Employer's Name, Employer's Address, City, State, and Zip Code.
Provide the Employee's E-mail and Employer's E-mail.
In the Notice to Employee section, describe the Job Title and Essential Duties. Attach additional pages if necessary.
Specify the Rate of Pay, Location of Job, and Hours/Days to be Worked.
Indicate the Date/Time to Report for Work.
Attach a copy of the report(s) from the authorized treating physician(s) that approve the job as suitable for the employee's condition.
In the Certification section, print your Name and Title.
Provide your E-mail Address, Signature, and the Date of signing.
Complete the City, State, and Zip Code fields at the bottom of the form.
Send a copy of the completed form to the employee and their counsel, if represented.

Once you have completed the form, ensure that it is sent to the appropriate parties within the required timeframe. This will help facilitate the employee's return to work and maintain compliance with the relevant regulations.

Your Questions, Answered

What is the WC-240 form?

The WC-240 form is a notice used by employers in Georgia to inform employees about an offer of suitable employment. This is required by Georgia law, specifically O.C.G.A. 34-9-240 and Board Rule 240. The form outlines job details that match the employee's impaired condition.

Who needs to receive the WC-240 form?

The employer must provide the WC-240 form to the employee and their legal counsel. This must be done at least ten days before the employee is expected to return to work. This ensures that both the employee and their representative are aware of the job offer and its details.

What information is included in the WC-240 form?

The form includes identifying information about the employee and employer, details of the job being offered, and a certification section. It specifies the job title, essential duties, rate of pay, location, and hours/days to be worked. Additionally, it includes a statement about the approval from the employee's authorized treating physician.

What happens if an employee refuses the job offer?

If an employee unjustifiably refuses to attempt the job offered after receiving the WC-240 notice, the employer or insurer can suspend the employee's income benefits. This suspension takes effect on the date the employee is scheduled to report for work.

Can an employee's income benefits be reinstated?

Yes, if the employee attempts to work but is unable to continue for fifteen scheduled workdays, their income benefits will be reinstated immediately. This provides some protection for employees who may struggle with the new job despite their best efforts.

What is the role of the authorized treating physician?

The authorized treating physician must approve the job as suitable for the employee's condition. A copy of this approval is attached to the WC-240 form. This ensures that the job offered aligns with the employee’s medical capabilities.

What should an employee do if they have questions about the job offer?

If an employee has questions regarding the job being offered, they should contact their employer directly. The employer's contact information should be provided on the form for this purpose.

What are the penalties for false statements on the WC-240 form?

Willfully making a false statement on the WC-240 form can lead to serious consequences. It is considered a crime and may result in penalties of up to $10,000 for each violation, as outlined in O.C.G.A. 34-9-18 and 34-9-19.

Where can I find more information about the WC-240 form?

For more details, individuals can contact the State Board of Workers’ Compensation at 404-656-3818 or 1-800-533-0682. Additionally, further information can be found on their official website at http://www.sbwc.georgia.gov.

Common mistakes

Incomplete Information: Failing to provide all required identifying details can lead to delays. Ensure the employee’s full name, Social Security Number, and Board Claim Number are accurately filled in.
Missing Attachments: Not including the physician’s report can invalidate the job offer. Always attach the necessary documentation that confirms the job is suitable for the employee’s condition.
Incorrect Timing: Submitting the form less than ten days before the expected return date can cause complications. Make sure to send the form in a timely manner to comply with legal requirements.
Failure to Notify: Neglecting to send a copy of the form to both the employee and their counsel can lead to misunderstandings. It is essential to provide notifications to all parties involved.
Not Certifying Properly: Omitting the certification section or failing to sign can render the form incomplete. Ensure that the person filling out the form certifies the job offer and includes their signature and date.

Documents used along the form

The WC-240 form is an essential document in the Georgia workers' compensation process, specifically for notifying employees about suitable employment offers. Alongside this form, several other documents are often utilized to ensure compliance and proper communication between employers and employees. Below is a list of related forms and documents that frequently accompany the WC-240.

Form WC-2: This is the "Employer's Report of Injury." It serves as the initial report filed by the employer when an employee is injured. This form provides critical information about the incident and helps establish the basis for the workers' compensation claim.
Form WC-3: Known as the "Employer's Wage Statement," this document outlines the employee's earnings and is used to calculate benefits. It is essential for determining the compensation amount an injured worker is entitled to receive.
Form WC-4: This is the "Employee's Claim for Benefits." It allows employees to formally claim their workers' compensation benefits. The completion of this form is necessary for the processing of the claim and to initiate benefit payments.
Form WC-5: The "Request for Hearing" form is used when disputes arise regarding the workers' compensation claim. If an employee or employer disagrees with a decision made by the insurance company, this form initiates the hearing process to resolve the issue.
Medical Reports: These documents are provided by authorized treating physicians. They detail the employee's medical condition and recovery progress, playing a crucial role in determining the suitability of the job offer outlined in the WC-240 form.
Return to Work Agreement: This document outlines the terms and conditions under which the employee will return to work. It typically includes job responsibilities, work hours, and any accommodations made for the employee's condition.

Understanding these forms and documents is vital for both employers and employees involved in the workers' compensation process. Proper documentation ensures compliance with legal requirements and facilitates smoother communication during the claims process.

Similar forms

The WC-240 form, known as the Notice to Employee of Offer of Suitable Employment, serves a specific purpose in the realm of workers' compensation in Georgia. Several other documents share similar functions or purposes, providing critical information and ensuring compliance with legal requirements. Here’s a list of nine documents that are akin to the WC-240 form:

WC-2 Form: This form is used to report an employee's claim for workers' compensation benefits. Like the WC-240, it ensures that both the employee and the Board are informed about the claim status and employment offers.
WC-3 Form: The WC-3 is a Notice of Claim Status. It informs the employee about the current status of their claim, much like the WC-240 informs about job offers related to their condition.
WC-4 Form: This is the Employee's Claim for Compensation form. It allows employees to formally request benefits, paralleling how the WC-240 communicates job offers to employees.
WC-5 Form: The WC-5 is a Notice of Payment of Compensation. It details the compensation being paid to the employee, similar to how the WC-240 outlines job offers and conditions related to benefits.
WC-6 Form: This form is used for the Report of Injury. It serves to notify the Board about an injury, akin to how the WC-240 notifies employees of job offers after an injury.
WC-7 Form: The WC-7 is a Notice of Termination of Benefits. It informs employees when their benefits are being terminated, similar to the implications of refusing a job offer outlined in the WC-240.
WC-8 Form: This is the Employee's Request for Hearing form. It allows employees to contest decisions made regarding their claims, paralleling the WC-240's role in communicating job offers.
WC-9 Form: The WC-9 is used for the Employee's Waiver of Compensation. It allows employees to waive their rights to compensation, similar to how the WC-240 addresses job acceptance and refusal.
WC-10 Form: This is the Employer's Report of Injury. It provides information from the employer's perspective, just as the WC-240 conveys employment offers to the employee.

Each of these documents plays a vital role in the workers' compensation process, ensuring that employees and employers are informed and compliant with the necessary regulations. Understanding their similarities can help clarify the overall system and its functions.

Dos and Don'ts

When filling out the WC-240 form in Georgia, it is crucial to adhere to certain guidelines to ensure accuracy and compliance. Here are seven important dos and don'ts to keep in mind:

Do provide complete identifying information, including the employee's full name, Social Security Number, and details about the injury.
Don't leave any sections blank. Incomplete forms may lead to delays or issues with the employee's benefits.
Do attach all necessary documentation, such as reports from authorized treating physicians that approve the job as suitable for the employee's condition.
Don't forget to send a copy of the form to both the employee and their legal counsel at least ten days before the expected return to work date.
Do clearly outline the job title, essential duties, rate of pay, and other relevant job details to avoid confusion.
Don't misrepresent the job offer or the employee's condition. This can lead to serious legal consequences.
Do ensure that the certification section is completed accurately, including the signature and date, to validate the offer.

Following these guidelines will help streamline the process and ensure that all parties understand their rights and responsibilities regarding the job offer.

Misconceptions

Understanding the WC-240 form in Georgia is crucial for both employees and employers in the workers' compensation process. However, several misconceptions can lead to confusion. Here are seven common misconceptions about the WC-240 form:

The WC-240 is optional for employers. This form is required by law when an employer offers suitable employment to an injured employee.
Employees do not need to respond to the WC-240. Employees must acknowledge the job offer and may need to accept or decline the position as per the instructions provided.
The job offered must be the same as the employee's previous position. The employer can offer a different job that is suitable for the employee's current condition.
Employers can file the WC-240 without notifying the employee. Employers must provide the form to both the employee and their counsel at least ten days before the return-to-work date.
Refusing the job offer has no consequences. If an employee unjustifiably refuses the job, the employer may suspend income benefits starting from the scheduled return date.
The WC-240 form is only for permanent job offers. The form can also be used for temporary job offers that accommodate the employee's limitations.
All job offers are automatically approved by the treating physician. The job must be explicitly approved by the authorized treating physician, and documentation must be attached to the form.

Being aware of these misconceptions can help ensure that both employees and employers navigate the workers' compensation process more effectively.

Key takeaways

When filling out and using the WC-240 Georgia form, keep these key points in mind:

Purpose of the Form: This form notifies an employee about a job offer that is suitable for their condition, as required by Georgia law.
Timeliness is Crucial: The employer must provide this form to the employee and their legal counsel at least ten days before the employee is expected to return to work.
Attachments Required: Include a copy of the report from the authorized treating physician that approves the job as suitable for the employee's condition.
Consequences of Refusal: If the employee unjustifiably refuses the job offer, the employer can suspend income benefits starting from the scheduled work date.
Job Details Matter: Clearly outline the job title, essential duties, pay rate, location, and work hours in the form.
Certification Requirement: The employer must certify that the job offer is made in good faith and that the physician's approval was obtained within the last 60 days.

Understanding these key points can help ensure that both employees and employers navigate the process smoothly and comply with Georgia's workers' compensation regulations.