C 108 Form Ohio PDF Details

Every state has different requirements when it comes to filing taxes. For those in Ohio, there is a specific form that needs to be filed in order to declare your income and expenses. The C 108 form is used for this purpose, and it can be filled out by individuals or businesses. Knowing how to complete this form is essential, so make sure you are familiar with the process before you file. Thankfully, our guide will walk you through everything you need to know.

QuestionAnswer
Form NameC 108 Form Ohio
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameswaiver bwc, ohio waiver appeal, appeal bwc form, worker waiver ohio search

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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

Nine-digit ZIP code

Employer name

Address

City

State

Nine-digit ZIP code

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. Non-attorneys may sign a waiver at the direction of the party they represent, but cannot sign at their independent discretion. When the required parties agree to waive their appeal rights, the order's appeal period automatically expires.

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 non-attorney representative for the injured worker who is signing at the direction of the injured worker.

Employer/Authorized representative

Date

X

I am a non-attorney representative for the employer who is signing at the direction of the employer.

BWC Administrator/Authorized representative

Date

X

May only waive appeal rights to IC orders.

BWC-1231 (Rev. 4/17/2012)

C-108