Georgia Workers’ Compensation Form WC-200a is the Change of Physician / Additional Treatment by Consent form that an injured worker and the employer or insurer file together with the Georgia State Board of Workers’ Compensation when both sides agree to switch the authorized treating doctor or add new treatment. It puts a mutual medical decision in writing, and once you file it the right way, it becomes a binding order of the Board under O.C.G.A. § 34-9-200(b).
This form only works when both parties say yes. If one side wants to force a change of doctor over the other’s objection, that is the different WC-200b form, which goes in front of a judge and carries a strict 15-day window to object. The version you should be holding is Revision 7/2025, which the Board updated in Section C language during its 2025 form changes, so confirm that date in the bottom corner before you write anything. Georgia processes tens of thousands of new workers’ comp claims each year through its ICMS electronic system, and a clean WC-200a is one of the fastest, cheapest ways to lock in agreed medical care without a hearing.
Here is what you will walk away knowing:
- 🩺 What the WC-200a does and exactly who has to sign it before it counts
- 📋 The documents and claim details you must gather before you open the form
- ✍️ A line-by-line, box-by-box walkthrough of all four sections in plain English
- 👥 Three real filled-out examples that show what to write in each field
- ⚠️ The filing mistakes that get this form rejected or ignored, and how to dodge every one
What the Form Is and Who Must File It
Form WC-200a is the State Board’s consent document for changing or adding medical care in an open workers’ compensation claim. It tells the Board, the insurer, and the doctors that the injured worker and the employer have agreed on a new authorized treating physician (ATP) or on extra treatment from a specialist. The form exists because Georgia law lets the employer control medical care through a posted panel of physicians, and any change away from that panel normally needs Board involvement under Board Rule 200. The WC-200a is the shortcut that skips a hearing when nobody is fighting.
The people who must sign are the employee (or the employee’s attorney) and the employer or insurer (or their attorney). A WC-200a with only one signature is not an agreement and the Board will not treat it as approved. The signing parties are the only ones who can bind the claim, which is why the doctor’s office does not sign this form even though the change is all about them.
You file this form only when a claim already exists. The instructions on the form state plainly that a Form WC-1 (Employer’s First Report of Injury) or a Form WC-14 (Notice of Claim/Request for Hearing) must already be on file with the Board first. The receiving agency is the State Board of Workers’ Compensation in Atlanta, the governing statute is O.C.G.A. § 34-9-200, the deadline is “before treatment so the bills get paid,” and the penalty for getting it wrong is a treatment delay or unpaid medical bills that fall back on the worker. Each piece feeds the next: no underlying claim means no jurisdiction, no jurisdiction means the form cannot become an order, and no order means the new doctor’s care may not be covered.
Before You Start: Documents and Information You Need
Gathering your facts before you open the form saves you from guessing in a box and triggering a rejection. Most WC-200a problems trace back to one missing number, not to the agreement itself. Pull these items together first so you can fill the form in one sitting.
- Board Claim Number — the unique number the Board assigned when the WC-1 or WC-14 was filed; without it the Board cannot match the form to your file and it sits unprocessed.
- Date of injury — the exact date the accident happened, because the Board indexes the claim by this date and a wrong date can attach your form to the wrong claim.
- Employee’s full legal name and mailing address — must match the name already on the claim, since a mismatch makes the Board question whether it is the same person.
- County of injury — the Georgia county where the accident occurred, which sets venue and is printed on the original claim documents.
- Current authorized treating physician’s name and full address — you cannot show a “change” without naming the doctor you are leaving.
- New or additional physician’s name and full address — the doctor you are moving to or adding, including city, state, and ZIP so the Board can serve them.
- The effective date of the change — the date coverage for the new doctor begins; bills before this date may not be paid.
- Signing authority details — the printed name, mailing address, e-mail, and Georgia Bar Number (if an attorney signs) for both the employee side and the employer side.
If any item is missing, the consequence is concrete. A missing claim number leaves the form unmatched in the Board’s system. A missing physician address means the Board cannot serve the doctor, which can stall billing approval. Collect every item up front and the rest of the process is fast.
Where to Get the Form and How to Access It
The only version you should use is the official PDF from the State Board. Download the current Revision 7/2025 WC-200a directly from the Board’s forms library, where it lives alongside every other WC form. Using a stale copy from a third-party site is the most common way to file an outdated Section C that the Board no longer accepts.
You can complete the form three ways. You can fill the PDF on a computer using a free reader, which gives you clean, typed text that is easy to read. You can print it and complete it by hand in black ink, writing in clear block capitals. Or, if you are an attorney or insurer with a Board login, you can prepare and file it inside the ICMS electronic portal, which is the channel most professional filers use.
The Board provides all forms free of charge, and you can request paper copies by calling the State Board at 404-656-3870. If you have questions while filling it out, the form itself lists 404-656-3818 or 1-800-533-0682 for help. There is no fee to file a WC-200a, so any site that charges you to “submit” the form is selling you a service the Board gives away. Self-represented workers most often download the PDF, fill it on screen, and mail it, while attorneys file through ICMS.
Step-by-Step: How to Fill Out Form WC-200a Line by Line
The WC-200a has a header block plus four lettered sections: A. Identifying Information, B. Physicians / Treatment, C. Agreement, and D. Certificate of Service. Work top to bottom and do not skip the header, because the case-matching fields live there. Below, each field gets its own walkthrough with an example entry, an edge case, the mistake to avoid, and the myth to drop.
Header: Board Claim No., Employee Name, M.I., and Date of Injury
The header asks for the Board Claim No., the Employee Last Name, Employee First Name, the middle initial (M.I.), and the Date of Injury. These are the fields the Board uses to attach your form to the right open claim. Enter the claim number exactly as it appears on your prior filings, type the employee’s legal name, add the single middle initial, and write the injury date in MM/DD/YYYY format.
For example, Maria Lopez writes her claim number 2024-012345, her last name LOPEZ, first name MARIA, M.I. G, and date of injury 03/14/2025.
The common edge case is a worker who does not know the Board Claim Number because the employer filed the WC-1. In that case, call the Board at 404-656-3870 and give your name and injury date to retrieve it rather than guessing.
The mistake filers make here is transposing the claim number digits, and the direct consequence is that the form never matches your file and the agreement never becomes an order. A widespread misconception is that the claim number and the insurer’s internal file number are the same; they are not, and only the Board claim number belongs in this box.
Section A: Employee Identifying Information
Section A asks for the employee’s County of Injury, Mailing Address, E-mail Address, City, State, and Zip Code. This is how the Board confirms who the worker is and where to send notices. Enter the Georgia county where the accident happened, then the worker’s current mailing address line, e-mail, city, state, and ZIP.
For example, Maria Lopez enters county FULTON, address 482 Maple Ave, e-mail maria.lopez@email.com, city Atlanta, state GA, ZIP 30312.
A frequent edge case is a worker who has moved since the injury. Always use the current mailing address so notices reach you, even if it differs from the address on the original WC-1.
The mistake here is entering the employer’s county instead of the county where the injury occurred, and the consequence is a venue mismatch that can delay processing. The myth to drop is that “County of Injury” means where you live; it means where the accident happened.
Section B, Field 1: Currently Authorized Treating Physician
Field B(1) asks you to name the currently authorized treating physician and that doctor’s mailing address, city, state, and ZIP. This establishes the starting point of the change. Write the current ATP’s full name as “Dr.” plus the name, then the complete office address.
For example, Maria Lopez enters Dr. James Carter, address 100 Clinic Dr, city Atlanta, state GA, ZIP 30303.
The edge case appears when the worker has never actually treated with the panel doctor listed by the employer. List the doctor of record on the claim, and if no ATP exists, note that in Section B(3) so the Board understands the history.
The mistake is leaving this blank because “we’re switching anyway,” and the consequence is the Board cannot see what you are changing from, which can stall approval. The misconception is that the current doctor must consent; the current doctor does not sign and does not have to agree.
Section B, Field 2: Physician for Whom Authorization Is Requested
Field B(2) asks for the doctor for whom authorization is requested — the new or additional physician — with full name and address. This names the doctor the worker will treat with going forward. Enter the new doctor’s name, mailing address, city, state, and ZIP.
For example, Maria Lopez enters Dr. Aisha Rahman, address 55 Specialist Pkwy, city Marietta, state GA, ZIP 30060.
The edge case is a new doctor with multiple office locations. List the specific office where the worker will actually be treated so billing and service go to the right place.
The mistake is giving a clinic group name instead of an individual physician, and the consequence is that the Board and insurer cannot tie approval to one provider. The myth is that any specialty is automatically covered; the authorized treatment must connect to the work injury.
Section B, Field 3: The Additional Treatment Authorized
Field B(3) is a free-text line asking what additional treatment is authorized. Use it when the agreement adds a specialist or specific care rather than swapping the main doctor. Describe the treatment plainly, such as a referral type or therapy.
For example, Marcus Reed writes Orthopedic evaluation and physical therapy for left knee.
The edge case is a pure change of physician with no added treatment. In that situation you may leave B(3) blank and rely on Section C box 1, because the change itself is the action.
The mistake is writing something vague like “as needed,” and the consequence is the insurer disputing scope later. The misconception is that this line approves unlimited future care; it approves the treatment described, tied to the injury.
Section C: The Agreement Checkboxes (Box 1 vs. Box 2)
Section C is the heart of the form and offers two checkboxes you must choose between. Box 1 is for a change of treating physician; Box 2 is for additional treatment while keeping a primary doctor. Check only the box that matches your situation, fill in the doctor’s name on that line, and enter the effective date in MM/DD/YYYY.
For Box 1, Maria Lopez checks box 1, names Dr. Aisha Rahman, and enters effective date 06/01/2026. For Box 2, Marcus Reed checks box 2, names the additional Dr. Aisha Rahman, enters effective 06/01/2026, and names the primary treating physician Dr. James Carter.
The edge case is wanting both a change and added treatment. Check the box that reflects the true legal action and describe the rest in B(3); do not check both unless the facts truly support it.
The mistake here is the single most common WC-200a error: checking Box 1 when you mean Box 2, or leaving the effective date blank. The consequence is that bills before a blank or wrong effective date may go unpaid. The misconception is that the boxes are interchangeable; Box 1 replaces the doctor while Box 2 adds one, and the Board treats them differently. Note that the Revision 7/2025 update changed the wording in this section, so use only the current form.
Section C: Signatures, Printed Names, and GA Bar Number
Below the checkboxes, Section C requires the Signature (Employee or Representative) and the Signature (Employer or Representative), each with a printed name, mailing address, city, state, ZIP, e-mail, and, for attorneys, a GA Bar Number. Both sides must sign for the agreement to exist. Sign in ink (or e-sign in ICMS), print the name, and complete the contact block.
For example, Maria Lopez signs and prints Maria Lopez on the employee side, while adjuster Janet Powell signs and prints Janet Powell on the employer side with her company address.
The edge case is representation by counsel. When an attorney signs, the attorney prints their name and enters their GA Bar Number; a pro se worker leaves the Bar Number blank.
The mistake is one party signing and filing before the other signs, and the consequence is an incomplete form the Board cannot approve. The misconception is that a verbal “yes” or an e-mail is enough; only the signed form binds the parties.
Section D: Certificate of Service
Section D is the Certificate of Service, a checkbox and signature line certifying that you sent a copy of the form to all parties, counsel, the named medical providers, and the State Board at 270 Peachtree Street, N.W., Atlanta, Georgia 30303-1299. Check the box, sign, and add your e-mail, date, and phone number. This proves everyone who needs the form actually received it.
For example, Janet Powell checks the box, signs, enters e-mail jpowell@insurer.com, date 06/01/2026, and phone 404-555-0150.
The edge case is forgetting to serve the doctors. The form specifically requires serving the named medical providers, so send copies to both the old and new physician offices, not just the parties.
The mistake is filing with the Board but never serving the new doctor, and the consequence is the doctor’s office not knowing it is authorized, which delays treatment and billing. The misconception is that the Board serves everyone for you; you must complete service and certify it.
Three Filled-Out Examples Using Real Scenarios
These three fact patterns cover the situations filers see most. Each follows one named person through the major fields so you can see exactly what goes where.
Scenario 1 — Maria Lopez switches to a new authorized treating physician by mutual consent. Maria hurt her back at a Fulton County warehouse and wants to move from the panel doctor to a back specialist both sides agree on.
| Form Section | What Maria Enters |
|---|---|
| Board Claim No. | 2024-012345 |
| Employee Name / M.I. | LOPEZ, MARIA G |
| Date of Injury | 03/14/2025 |
| County of Injury | FULTON |
| B(1) Current physician | Dr. James Carter, Atlanta, GA 30303 |
| B(2) New physician | Dr. Aisha Rahman, Marietta, GA 30060 |
| Section C box checked | Box 1 — change of physician |
| Effective date | 06/01/2026 |
| Employee signature | Maria Lopez (pro se, no Bar No.) |
| Certificate of Service | Checked, signed, copies sent to both doctors and the Board |
Scenario 2 — Marcus Reed adds a specialist while keeping his primary doctor. Marcus injured his left knee and keeps his current ATP for general care but adds an orthopedist by agreement.
| Form Section | What Marcus Enters |
|---|---|
| Board Claim No. | 2025-067890 |
| Employee Name / M.I. | REED, MARCUS T |
| Date of Injury | 11/02/2025 |
| County of Injury | COBB |
| B(2) Additional physician | Dr. Aisha Rahman, Marietta, GA 30060 |
| B(3) Additional treatment | Orthopedic evaluation and PT for left knee |
| Section C box checked | Box 2 — additional treatment |
| Primary treating physician | Dr. James Carter |
| Effective date | 06/01/2026 |
| Certificate of Service | Checked, signed, copies served on all parties and providers |
Scenario 3 — Attorney David Nguyen files on behalf of injured worker Aisha Bello. Aisha is represented, and her lawyer and the insurer’s lawyer agree to change her doctor.
| Form Section | What David (for Aisha) Enters |
|---|---|
| Board Claim No. | 2024-099001 |
| Employee Name / M.I. | BELLO, AISHA N |
| Date of Injury | 07/21/2024 |
| County of Injury | DEKALB |
| B(1) Current physician | Dr. Priya Shah, Decatur, GA 30030 |
| B(2) New physician | Dr. Aisha Rahman, Marietta, GA 30060 |
| Section C box checked | Box 1 — change of physician |
| Employee representative | David Nguyen, GA Bar No. 123456 |
| Employer representative | Opposing counsel, GA Bar No. 654321 |
| Certificate of Service | Checked, signed by counsel, served on all parties and providers |
How to File the Completed Form
You can file the WC-200a through three channels, and each leaves a different proof of filing you should keep. There is no filing fee on any channel.
- By mail: Send the signed original to the State Board of Workers’ Compensation, 270 Peachtree Street, N.W., Atlanta, Georgia 30303-1299. Use certified mail with return receipt as your proof, and expect routine processing once it matches your claim. No payment is needed.
- Electronically (ICMS): Attorneys and insurers with credentials file through the ICMS / EDI portal, which timestamps the submission and gives you an electronic confirmation to save. This is the fastest channel and the one professional filers use.
- In person / by phone for copies: You can request paper forms by calling 404-656-3870, and general filing questions go to 404-656-3818 or 1-800-533-0682.
Whatever channel you use, you must also complete the Certificate of Service by sending copies to all parties, counsel, and both the old and new doctor offices. Keep a date-stamped copy of everything you send, because your certified-mail receipt or ICMS confirmation is your evidence that the agreement is on file and effective.
What Happens After You File
Once a properly executed WC-200a reaches the Board with copies served on the medical providers, the form is deemed approved and made the order of the Board under O.C.G.A. § 34-9-200(b). You do not wait for a judge’s signature or a hearing, because the parties’ agreement is the approval. That is the whole point of the consent form.
After approval, the new or additional physician becomes authorized, and the employer or insurer is responsible for necessary and reasonable medical expenses from the effective date forward. The worker can begin treating with the agreed doctor, and the doctor’s office can bill the insurer with confidence that the care is covered. Bills for dates before the effective date may not be covered, which is why that field matters so much.
If the form is incomplete — a missing signature, a blank claim number, or no certificate of service — the Board may not treat it as an order, and the “approval” never happens. In that case the new doctor’s bills can bounce back to the worker. Always confirm the form processed by keeping your proof of filing and following up with the Board if treatment authorization stalls.
Mistakes to Avoid When Filling Out the Form
Each field on the WC-200a is its own chance to slip, so review this list before you sign.
- Filing without a WC-1 or WC-14 on file first — the Board has no claim to attach it to, so the form goes nowhere.
- Wrong or missing Board Claim Number — the form never matches your file and the agreement is never approved.
- Using an outdated form version — pre-7/2025 Section C language may be rejected by the Board.
- Checking Box 1 when you mean Box 2 — you change the doctor when you meant to add one, distorting the agreement.
- Leaving the effective date blank — bills have no clear start date and may be denied.
- Only one party signs — without both signatures there is no agreement and no order.
- Naming a clinic instead of a specific doctor — the insurer cannot tie authorization to one provider.
- Forgetting to serve the doctors — the new office never learns it is authorized and treatment stalls.
- Using the wrong “County of Injury” — a venue mismatch slows processing.
- Skipping the Certificate of Service — the Board may not deem the form approved without proof of service.
- Attorney omits the GA Bar Number — the Board cannot confirm authority to sign for a party.
- Paying a third-party site to “file” it — you spend money on a free service and may submit a stale form.
Do’s and Don’ts
Do:
- Do confirm a WC-1 or WC-14 is already on file, because the WC-200a depends on an existing claim.
- Do download the current Revision 7/2025 form, so your Section C language is accepted.
- Do check only one Section C box, because Box 1 and Box 2 mean different things.
- Do fill in the effective date, since it controls which bills get paid.
- Do get both signatures before filing, because a one-sided form is not an agreement.
- Do serve copies on both doctor offices, so treatment and billing start smoothly.
Don’t:
- Don’t guess the Board Claim Number, because a wrong number leaves the form unmatched.
- Don’t name a clinic group in place of a physician, since authorization attaches to an individual doctor.
- Don’t leave the Certificate of Service blank, because the Board may not deem the form approved.
- Don’t assume a verbal or e-mail agreement counts, since only the signed form binds the parties.
- Don’t pay anyone to “submit” the form, because the Board accepts it free.
- Don’t use this form to force a change over an objection, because that requires the WC-200b and a judge.
Filing on Your Own vs. With an Attorney
Whether to file the WC-200a yourself depends on how settled the agreement is and how complex your claim has become.
Pros of filing on your own:
- It is free, so you keep all of your benefit money.
- It is fast for a simple, agreed change with no dispute.
- You control the timing and do not wait on a lawyer’s calendar.
- The form is short and the fields are straightforward once you gather your facts.
- You learn your own claim, which helps with future filings.
Cons of filing on your own (and pros of using an attorney):
- A small field error, like the wrong box or a blank effective date, can cost you covered care.
- You may not know if “consent” is truly in your best interest versus fighting for a better doctor.
- An attorney spots whether the case should really be a WC-200b dispute instead.
- Counsel handles service on all parties and providers correctly the first time.
- A lawyer can read the 2025 rule changes and case law, like the recent SBWC updates, that shape how the form is read.
WC-200a vs. WC-200b at a Glance
These two forms look related but do opposite things, and confusing them is a costly error.
| Feature | What It Means |
|---|---|
| WC-200a | Used when both parties agree to change or add a doctor |
| WC-200b | Used when one party asks a judge to change the doctor over objection |
| Signatures on WC-200a | Both employee and employer/insurer must sign |
| WC-200b objection window | The other side has only 15 days to object |
| WC-200a outcome | Deemed approved as a Board order on filing |
| WC-200b outcome | Decided by an administrative law judge |
FAQs
Do I file the WC-200a before or after a claim exists?
No. You file it after a Form WC-1 or WC-14 is already on file with the Board, because the WC-200a depends on an open claim to attach to.
Is there a fee to file Form WC-200a?
No. The State Board of Workers’ Compensation provides and accepts all forms free of charge, so any site charging you to “submit” it is selling a free service.
Do I check Box 1 or Box 2 in Section C if I am just switching doctors?
Yes, check Box 1 for a straight change of treating physician; use Box 2 only when you keep a primary doctor and add treatment from another physician.
Do I write the new doctor’s name or the old doctor’s name in Section B(1)?
No, Section B(1) is for the currently authorized doctor you are leaving; the new doctor goes in B(2) and in the Section C line you check.
Does the doctor have to sign the WC-200a?
No. Only the employee (or representative) and the employer or insurer (or representative) sign; the named physicians receive copies but do not sign the form.
Do both parties really need to sign for the form to work?
Yes. Without both the employee-side and employer-side signatures there is no agreement, and the Board will not deem the form approved as an order.
Does the effective date in Section C actually matter?
Yes. It sets when coverage for the new doctor begins, and medical bills dated before the effective date may not be paid by the employer or insurer.
Do I need a Georgia Bar Number in the signature block?
No, only if an attorney signs; a self-represented worker leaves the GA Bar Number blank and simply signs and prints their own name.
Does the Board serve copies on the doctors for me?
No. You must complete the Certificate of Service yourself, sending copies to all parties, counsel, and both the old and new medical providers.
Can I use the WC-200a to force my employer to change my doctor?
No. The WC-200a is only for agreed changes; a contested change uses Form WC-200b and is decided by an administrative law judge.
Do I have to use the newest version of the form?
Yes. Use Revision 7/2025, because the Board updated the Section C language that year and an outdated form may be rejected.
Does filing the WC-200a guarantee my new doctor’s bills get paid?
Yes, for necessary and reasonable treatment from the effective date forward, as long as the form is fully completed, signed by both parties, and properly served.
Is willfully putting false information on this form a crime?
Yes. Willfully making a false statement to obtain or deny benefits is a crime with penalties up to $10,000 per violation under O.C.G.A. § 34-9-18 and § 34-9-19.
Do I list the county where I live or where I got hurt?
No to where you live; the “County of Injury” field is the Georgia county where the accident happened, which sets the venue for your claim.
Related reading
- How to Fill Out the Georgia Composite Medical Board PA License Application (+ FAQs)
- How to Fill Out Georgia Workers’ Comp Form WC-1 (w/Examples) + FAQs
- How to Fill Out Georgia Workers’ Comp Form WC-104 (w/Examples) + FAQs
- How to Fill Out Georgia Workers’ Comp Form WC-14 (w/Examples) + FAQs
- How to Fill Out Georgia Workers’ Comp Form WC-240 (w/Examples) + FAQs
- How to Fill Out Georgia Workers’ Comp Form WC-243 (w/Examples) + FAQs
- How to Fill Out California WCAB DWC-AD 1 (w/Examples) + FAQs