Se habla español
Click to Call

Board Rule 61b11 Form Wc14a Request To Change Information On A Previously Filed Form Wc14

A party or attorney shall file this form with the Board when requesting correction of a mistake concerning the employee’s name, social security number, date of injury, or county of injury on a previously filed Form WC-14.  A Form WC-14A shall not be used to change an address of record, add additional parties, or additional dates of injury.  A new Form WC-14 shall be filed with the Board to add or amend any information pertaining to the employer, the insurer, the servicing agent or part of body injured, and to add an additional date of injury, hearing issue, or mediation issue.

To return to the Workers’ Compensation Rules Index, click on the “Rule” Button.

◂ Back to Blog
Seth Bader

Seth Bader Law Firm Logo

(678) 562-5595

Contact Us