C84 form ohio bwc 2026

1. Click ‘Get Form’ to open the C-84 form in the editor.
2. 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.
3. 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.
4. 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.
5. In Section 4, consider if you would participate in vocational rehabilitation. Your response will help BWC facilitate your return to work.
6. 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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