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Fill a Valid Wc 240 Georgia Template

The WC-240 Georgia form serves as a crucial document for employers to notify employees about an offer of suitable employment following a work-related injury. This form is designed to ensure that the job offered aligns with the employee's current capabilities, as mandated by Georgia law. It plays a vital role in the workers' compensation process, helping to facilitate the employee's return to work while maintaining compliance with state regulations.

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Contents

When navigating the complexities of workers' compensation in Georgia, the WC-240 form plays a crucial role in facilitating the return to work for employees recovering from injuries. This form serves as a formal notice from employers to employees, informing them of an available job that aligns with their current capabilities. It is designed to comply with Georgia law, specifically O.C.G.A. 34-9-240 and Board Rule 240. Employers are required to provide this notification at least ten days before the employee is expected to resume work, ensuring adequate time for the employee to assess the offer. The form includes essential details such as the job title, essential duties, rate of pay, location, and the expected hours or days of work. Moreover, it must be accompanied by documentation from the employee's authorized treating physician, confirming that the job is suitable for the employee's condition. Failure to accept a suitable job offer without justification can lead to the suspension of income benefits, emphasizing the importance of this communication. By fostering a transparent dialogue between employers and employees, the WC-240 form helps facilitate a smoother transition back to the workplace while ensuring compliance with state regulations.

Wc 240 Georgia Example

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

Download Wc 240 Georgia

Document Breakdown

Fact Name	Description
Purpose of Form	The WC-240 form is used by employers in Georgia to notify employees of an offer of suitable employment that aligns with their impaired condition.
Governing Laws	This form is governed by O.C.G.A. 34-9-240 and Board Rule 240, which outline the requirements for notifying employees about job offers.
Notification Requirement	Employers must provide this form to the employee and their counsel at least ten days before the expected return to work date.
Consequences of Refusal	If an employee unjustifiably refuses the job offer after receiving the WC-240, the employer may suspend income benefits starting from the scheduled report date.

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