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Fill a Valid Wc 240 Georgia Template

The WC-240 form is a crucial document used in Georgia to inform employees about an offer of suitable employment following a work-related injury. This form ensures that employees are aware of job opportunities that align with their current capabilities, as mandated by state law. By providing this notice, employers help facilitate a smoother transition back to work for injured employees.

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Common mistakes

Inaccurate Information: Providing incorrect details about the employee's name, Social Security number, or Board Claim number can lead to significant delays or complications in processing the form.
Missing Attachments: Failing to include the necessary reports from authorized treating physicians can invalidate the job offer. These reports must confirm that the job is suitable for the employee's condition.
Improper Timing: Submitting the form less than ten days before the expected return to work date can result in non-compliance with legal requirements. It is crucial to adhere to this timeline.
Neglecting to Notify: Not sending a copy of the form to both the employee and their counsel can create misunderstandings and may affect the employee's rights.
Inadequate Job Description: Providing vague or incomplete information about the job title, essential duties, or pay rate can lead to confusion. Clear and detailed descriptions are necessary for the employee to understand the offer.

Essential Points on This Form

What is the WC-240 form?

The WC-240 form, also known as the Notice to Employee of Offer of Suitable Employment, is used by employers in Georgia to inform employees about job offers that match their medical conditions. This form is required under Georgia law to ensure that employees are aware of suitable employment options after an injury.

Who is required to use the WC-240 form?

Employers are required to use the WC-240 form when they have a job offer for an employee who has suffered a work-related injury. This requirement is in accordance with O.C.G.A. 34-9-240 and Board Rule 240.

When must the WC-240 form be provided to the employee?

The employer must provide the WC-240 form to the employee and their legal counsel at least ten days before the employee is expected to return to work. This allows the employee adequate time to consider the job offer.

What information is included in the WC-240 form?

The WC-240 form includes identifying information about the employee and employer, details of the job offer (such as title, essential duties, pay rate, and location), and a certification section confirming that the job is suitable for the employee's condition as approved by their 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 notification, the employer or insurer may suspend the employee's income benefits starting from the scheduled report date for work. However, if the employee attempts the job but cannot continue for 15 scheduled workdays, their income benefits will be reinstated.

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 using the contact information provided in the WC-240 form. It’s important for the employee to clarify any uncertainties before making a decision.

What are the consequences of providing false information on the WC-240 form?

Willfully providing false information on the WC-240 form is considered a crime and can lead to penalties of up to $10,000 per violation. This serves as a serious reminder for both employers and employees to be truthful in their statements regarding employment and benefits.

How can I contact the State Board of Workers’ Compensation for more information?

For further inquiries, you can reach the State Board of Workers’ Compensation at 404-656-3818 or 1-800-533-0682. Additionally, you can visit their website at http://www.sbwc.georgia.gov for more resources and information.

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Wc 240 Georgia Sample

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

Key takeaways

Filling out the WC-240 form in Georgia is an important step for both employers and employees in the workers' compensation process. Here are some key takeaways to keep in mind:

Purpose of the Form: The WC-240 is used to notify employees about a suitable job offer that aligns with their current medical condition.
Timeliness Matters: Employers must provide this notice at least ten days before the employee is expected to return to work.
Attachments Required: A copy of the report from the authorized treating physician must be included to confirm that the job is suitable for the employee’s condition.
Consequences of Refusal: If an employee unjustifiably refuses the job offer, the employer may suspend their income benefits starting from the scheduled work date.
Reinstatement of Benefits: If the employee attempts the job but cannot continue for 15 scheduled workdays, their income benefits will be reinstated.
Contact Information: Employees should reach out to their employer if they have any questions regarding the job offer detailed in the form.
Good Faith Certification: Employers must certify that the job offer is made in good faith and that the physician’s approval is current.
Legal Implications: Providing false information on this form can lead to serious penalties, including fines up to $10,000.

Understanding these key points can help ensure a smoother process for both parties involved in the workers' compensation system in Georgia.

Document Characteristics

Fact Name	Fact Description
Purpose	The WC-240 form notifies an employee of an offer of suitable employment following an injury.
Governing Laws	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.
Attachment Requirement	The form must be filed with the Board as an attachment to a Form WC-2.
Job Offer Details	The form includes essential job details such as title, duties, pay rate, and location.
Physician Approval	A copy of the treating physician's report approving the job as suitable must be attached.
Refusal Consequences	If the employee unjustifiably refuses the job, the employer can suspend income benefits.
Reinstatement of Benefits	Income benefits will be reinstated if the employee attempts but fails to work for 15 scheduled days.
False Statements Penalty	Willfully making false statements on this form can lead to penalties of up to $10,000.