Ohio Form C 240 – Fill Out and Use This PDF

Ohio Form C 240 PDF Details

The Ohio C-240 form, officially titled the Settlement Agreement and Application for Approval of Settlement Agreement, is a critical document for those looking to settle workers' compensation claims with state-fund employers in Ohio. This form is required under Ohio Revised Code 4123.65 and necessitates signatures from both the injured worker and the employer, except in cases where the employer is no longer operational within the state. For claims involving employers that have transitioned to self-insurance, a separate form, the SI-42, needs to be filed, highlighting the form's adaptability based on the employer's current insurance status. Filing this application indicates an agreement between the injured worker and the employer to suspend all unresolved issues, while ongoing compensation and medical payments persist until the settlement is officially approved. The form underscores the responsibility of the state insurance fund to cover the costs of medical services, hospital bills, drugs, and medicines incurred before the settlement's effective date, provided they stem from the allowed conditions of the claims and conform to current medical payment guidelines. Conversely, any costs incurred post-settlement date fall on the injured worker, stressing the importance of understanding the financial implications of the settlement. It also contains a special notice for Medicare beneficiaries regarding the coordination of benefits, emphasizing the form's comprehensive approach to addressing various aspects of settling a workers' compensation claim.