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- Click ‘Get Form’ to open the Request for Temporary Total Compensation (C-84) in the editor.
- Begin with Section 1, where you will enter your demographics. Fill in your name, address, and contact information. This ensures BWC can reach you regarding your claim.
- Move to Section 2 to provide disability information. Indicate whether this is a new period of disability or an extension, and list the last day you worked if applicable.
- In Section 3, input your employment details. This helps BWC facilitate your return to work and manage payments effectively.
- Proceed to Section 4 for vocational rehabilitation information. Indicate if you would consider participating in this program.
- In Section 5, disclose any benefits or earnings received during your disability period. Be thorough in providing requested details.
- Finally, sign and date the form in Section 6. Ensure all information is accurate before submission.
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