C 108 Form Ohio – Fill Out and Use This PDF

The C-108 Ohio form, designed for use in workers' compensation cases, serves a specific purpose: it allows parties involved—whether the injured worker, the employer, or both—to officially waive their right to appeal decisions made by either the Bureau of Workers' Compensation (BWC) or the Industrial Commission of Ohio. This waiver is applicable only to the decision specified in the form and does not affect the parties' rights concerning any future appeals related to other orders. For ease and accessibility, this form can be completed and submitted through various means, including mailing, faxing, or online submission at ohiobwc.com.

Discover more about how to properly fill out and submit the C-108 Ohio form to ensure your rights and intentions are clearly communicated and understood. Click the button below to get started.

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C 108 Form Ohio PDF Details

The C-108 form is an official Ohio Bureau of Workers' Compensation (BWC) document used to waive the appeal period for a specific workers' compensation claim decision. Both the injured worker and the employer use this form when they agree not to contest an order from the BWC or the Industrial Commission of Ohio (IC).

The form requires key claim information: the injured worker's full name, date of injury, claim number, and employer details. All relevant parties must provide their signatures to confirm the mutual agreement. The waiver applies only to the specific order listed. It does not affect your right to appeal future orders on the same compensation claim.

This document helps streamline the workers' compensation process by allowing faster resolution when both parties accept a decision. For other Ohio BWC documents you may need during your claim, see our Ohio BWC C-9 form and the Workers' Compensation C-4 form.

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

How to Edit C 108 Form Ohio Online for Free

What Is the C-108 Form Ohio?

The C-108 Ohio form is an official PDF document issued by the Ohio Bureau of Workers' Compensation (BWC). It allows injured workers, employers, and their representatives to waive the right to appeal a specific BWC or Industrial Commission (IC) order. Signing the form means you accept the named decision and will not contest it during the appeal period.

How to Fill Out the C-108 Form Ohio

Access the PDF form. Download the C-108 PDF from ohiobwc.com or use the online editor above to complete it digitally.
Enter your claim information. Write the injured worker's full name, the date of injury, and the claim number exactly as they appear on BWC records.
Provide employer details. Enter the employer's name and contact information in the designated fields.
Identify the order being waived. Specify the BWC or IC order number and its issue date. The waiver applies only to this single order.
Gather all required signatures. The injured worker, the employer or their authorized representative, and any attorneys of record must sign and date the form.
Submit the completed waiver. Send the signed C-108 form to the Ohio BWC by mail, fax, or through the online submission portal at ohiobwc.com.

Frequently Asked Questions

What happens after I sign the C-108 waiver?
Once all parties sign and submit the C-108 form, you have officially waived the right to appeal that specific order. The BWC processes the document and the compensation decision becomes final for that claim item.

Does the C-108 affect future appeals?
No. The waiver only covers the single order listed on the form. You retain the right to appeal any future BWC or IC orders related to your workers' compensation claim.

Who must sign the C-108 Ohio form?
All parties identified in the relevant order must sign. This typically includes the injured worker and the employer or their authorized representative. Attorneys may sign on behalf of their clients when properly authorized.

For related forms used in Ohio workers' compensation claims, see our workers' compensation injury report and Ohio BWC C-9 form.