Reasons Forms Are Rejected

1. Board Claim Number – The BCN not listed [Rule 60(c)].
2. Section B, C or D – not completed on the WC-1.
3. SBWC ID # (5 digits) – not completed or incorrect.
4. Insurer/self-insurer – name and address not completed.
5. Claims office – name and address not completed.
6. Illegible Form – no fax copies.
7. Altered Form – do not highlight areas, do not extend front page to page.
8. Multiple dates of injury – a form must be filed for each date.
9. Claimant or Employer – address not completed.
10. Outdated Board forms – if you need Board forms contact the mailroom at 404-656-3870 or visit our website.

The WC-1 and WC-14 MUST be typed or printed in black ink.

If you have any questions, please call 404-656-3818 or 1-800-533- 0682.