Ga. Comp. R. & Regs. R. 115-3-.04 - Supporting Documents Required

The Board shall not take action on a claim made under this Chapter until all supporting documents requested by the Board have been received and filed with the Board. The following supporting documents, where applicable, shall be filed by the claimant or on his/her behalf:

(a) Copy of accident/incident report signed by investigating officers-State Patrol, County Police, City Police, Campus Police, Security Officer, etc., if applicable;

(b) claimant's affidavit concerning receipt of compensation from insurers or third parties on form provided by Board;

(c) if any insurance has been paid or is payable, a waiver of claim form executed by the insurer;

(d) receipted itemized repair bill, or two estimates of repair;

(e) physician's statement as to nature, cause and extent of injury or illness;

(f) sworn itemized list of all medical bills (physicians, hospital, drugs, etc.) with bills or copies of bills attached;

(g) sworn affidavit as to the value of property on which total loss is alleged;

(h) if property is a total loss and has been sold for salvage or will be sold for salvage, a sworn affidavit from dealer indicating the salvage value of the property or evidence showing the exact amount received for salvage;

(i) claimant's "Settlement Agreement, Covenant Not to Sue and Release", on form provided by Board:

(j) such other supporting evidence claimant may wish to provide, in affidavit form;

(k) such other supporting data or documentation as the Board may request in writing for proper evaluation of a particular claim.

Notes

Ga. Comp. R. & Regs. R. 115-3-.04

O.C.G.A. Sec. 28-5-85.

Original Rule entitled "Supporting Documents Required" was filed on March 24, 1983; effective April 13, 1983. Amended: F. Mar. 4, 1998: eff. Mar. 24, 1998.