Understanding the intricacies of the C-108 Ohio form is crucial for individuals and entities navigating the complexities of workers' compensation claims within the state. This form serves a pivotal role in the claims process, specifically addressing the waiver of the appeal period. It is designed for situations where the involved parties, including the injured worker, employer, and their representatives, agree to waive their right to appeal certain orders issued by the Bureau of Workers' Compensation (BWC) and the Industrial Commission of Ohio (IC). The form mandates detailed information about the claim, such as injured worker name, date of injury, claim number, and employer details. What stands out is the requirement for signatures from relevant parties, illustrating a mutual agreement to not contest the order in question. This waiver, however, is order-specific and does not impact the ability to appeal future orders related to the claim. The C-108 form also outlines the conditions under which various parties need to submit a waiver, emphasizing the collaborative nature of reaching such agreements. By facilitating a smoother resolution process, this form plays an essential role in the state's workers' compensation system, offering a clear pathway for parties seeking to expedite claim finalization by forgoing the appeal process.
| Question | Answer |
|---|---|
| Form Name | C 108 Form Ohio |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | waiver bwc, ohio waiver appeal, appeal bwc form, worker waiver ohio search |
Waiver of Appeal Period
Instructions
∙Please print or type.
∙Complete all applicable portions of this form.
∙Submit the form by mailing or faxing the signed and dated copy to the customer service office where the claim is located. You may also complete this form online at ohiobwc.com.
Claim Information
Injured worker name
Date of injury
Claim number
Address
City
State
Employer name
Address
City
State
Please read the information below before signing this form.
Ohio workers' compensation law permits parties to a claim to waive, in writing, their right to appeal orders issued by BWC and the Industrial Commission of Ohio (IC). To waive an order's appeal period, the following must be filed in writing.
OFor orders that include the allowance of anything other than compensation, the injured worker and employer must submit a signed waiver. If the employer is out of business in Ohio, only the injured worker must submit a waiver.
OFor orders that include only the allowance of compensation, the employer must submit a signed waiver. If the employer is out of business no waiver is needed.
OFor IC orders, BWC must submit a signed waiver, in addition to the injured worker and/or employer.
The injured worker, the employer or attorneys who represent them can sign waivers.
This request for waiver of appeal applies only to the order specified below, not to all past or future orders affecting the claim. Therefore, waiving your right to appeal an order will not prohibit you from appealing other orders pertaining to the claim.
The undersigned agree to waive the right to appeal the order with the mailing date of |
, |
|
which was issued in the above named claim. |
|
|
Injured worker/Authorized representative
X
Date
I am a
Employer/Authorized representative |
Date |
X
I am a
BWC Administrator/Authorized representative |
Date |
X
May only waive appeal rights to IC orders.