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Click ‘Get Form’ to open the C-84 form in the editor.
Begin by filling out your demographics in Section 1. Include your name, address, claim number, and contact information. This ensures BWC can reach you regarding your application.
In Section 2, indicate whether you are applying for a new period of temporary total compensation or an extension. If it's a new period, provide the last date you worked and list all medical providers treating you for your work-related disability.
Proceed to Section 3 to detail your employment information. State your occupation at the time of injury and answer questions about your job status and capabilities.
In Section 4, consider if you would participate in vocational rehabilitation. Your response will help BWC facilitate your return to work.
Finally, complete Section 5 by indicating any benefits received during your disability period. Ensure all fields are filled accurately before signing in Section 6.
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A claimant must file a notice of injury or death with BWC or the Ohio Industrial Commission (IC) within one year of the injury or death.
How much do you get for permanent partial disability in Ohio?
Permanent Partial Disability (PPD) Permanent partial awards are generally paid as a lump sum settlement or in biweekly installments. In 2025, the maximum weekly rate is $410.33. The exact amount you receive depends on the approved impairment rating and the schedule set by Ohio law.
What is the statute of limitations for BWC in Ohio?
State Deadlines for Filing a Workers Compensation Claim AlabamaWithin 2 years from the date of injury or the date of the last compensation payment California Within 1 year from the date of injury Colorado Within 2 years from the date of injury or within 3 years with a compelling reason48 more rows
How to fill out a Workmans Comp form?
0:17 2:00 Be accurate and thorough in your descriptions. Next fill out the section about your employment. ThisMoreBe accurate and thorough in your descriptions. Next fill out the section about your employment. This will include your hire date and your job duties. You will also need to provide your wage.
How far back can you claim workers comp?
Ohio law, Ohio Revised Code 2305.10 (A), states that most personal injury claims, including those arising from car accidents, must be filed within two years of the cause of action occurring. This means that the time frame starts from the date of negligence or discovery.
c84 form
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People also ask
Is Ohio BWC mandatory?
As an Ohio employer with one or more employees, Ohio law requires you to have workers compensation coverage.
Related links
Workers Compensation Self-Insurance Program Frequently
Lost Time claims must be filed with the Ohio Bureau of. Workers Compensation (BWC) and assigned a BWC claim number. You will be required to complete a First
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