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Preview - C 108 Ohio Form
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.
Document Properties
| Fact Name | Details |
|---|---|
| Form Purpose | The C-108 form is used to waive the appeal period for orders issued by the Bureau of Workers' Compensation (BWC) and the Industrial Commission of Ohio (IC). |
| Governing Law | This form is governed by Ohio workers' compensation law, which outlines the rights to appeal orders. |
| Submission Method | Individuals can submit the completed form by mailing or faxing it to the customer service office where the claim is located, or online at ohiobwc.com. |
| Required Signatures | The injured worker and employer must sign the waiver, depending on the nature of the order. Non-attorneys can sign under specific conditions. |
| Specificity of Waiver | Waiving the right to appeal applies only to the specific order mentioned in the form, not to any other orders related to the claim. |
| Expiration of Appeal Period | Once the required parties agree to waive their appeal rights, the appeal period for that order automatically expires. |
Documents used along the form
When navigating the Ohio workers' compensation system, several forms and documents often accompany the C 108 Ohio form. Understanding these documents can help ensure a smoother process and better communication among all parties involved. Here’s a brief overview of some commonly used forms.
- C-92: This form is used to request a hearing before the Industrial Commission of Ohio. It allows injured workers or employers to contest decisions made by the Bureau of Workers' Compensation (BWC) regarding claims, benefits, or compensations.
- C-86: The C-86 form is a request for a change in the injured worker's claim status. It can be utilized to adjust the compensation rate or to address any disputes related to the claim.
- C-150: This document serves as a notice of appeal. If a party disagrees with a decision made by the Industrial Commission, they can file this form to formally appeal the decision.
- C-140: The C-140 form is used for reporting a change in the injured worker’s medical condition. It helps to keep the BWC updated on the worker's status, which can affect their benefits and compensation.
- C-104: This form is the application for a lump sum settlement. It allows injured workers to request a one-time payment instead of ongoing compensation, usually after reaching maximum medical improvement.
- C-89: The C-89 form is a request for a reconsideration of a claim decision. If a party believes that a mistake was made in the claim's handling, this form can be submitted to seek a review.
- Non-compete Agreement Form: To understand workplace restrictions, explore our overview of the Non-compete Agreement essentials for clarity on its implications.
- BWC-7: This is a form used to report an injury or occupational disease. Employers must complete this form to notify the BWC of any workplace injuries, which initiates the claims process.
Each of these forms plays a crucial role in the workers' compensation process in Ohio. Familiarizing yourself with them can empower you to navigate your claim more effectively and ensure that your rights are protected. If you have questions about these documents, consider reaching out to a legal professional for guidance.
Guidelines on Filling in C 108 Ohio
Completing the C 108 Ohio form is a straightforward process that requires careful attention to detail. This form must be filled out accurately to ensure that all necessary parties waive their right to appeal an order related to a workers' compensation claim. Follow the steps below to complete the form correctly.
- Begin by printing or typing the form clearly to ensure legibility.
- Fill in the "Claim Information" section:
- Enter the injured worker's name.
- Provide the date of injury.
- Input the claim number.
- Fill in the injured worker's address, including city, state, and nine-digit ZIP code.
- Enter the employer's name.
- Provide the employer's address, including city, state, and nine-digit ZIP code.
- Read the waiver information carefully to understand the implications of waiving the appeal period.
- Indicate the mailing date of the order being waived.
- Sign the form as the injured worker or authorized representative. Include the date of signing.
- If applicable, the employer or authorized representative must also sign the form, along with the date of signing.
- If the order pertains to the Industrial Commission (IC), a BWC Administrator or authorized representative must sign the form, including the date of signing.
- Once completed, submit the signed and dated form by mailing or faxing it to the customer service office where the claim is located. Alternatively, the form can be completed online at ohiobwc.com.
After submitting the form, it is important to keep a copy for your records. This will serve as confirmation of the waiver request. Be mindful that waiving the right to appeal applies only to the specific order mentioned in the form and does not affect the ability to appeal other orders related to the claim.
Common mistakes
When filling out the C 108 Ohio form, one common mistake is failing to complete all applicable portions. Each section of the form is important, and missing information can lead to delays or even rejection of the waiver. Make sure to provide details like the injured worker's name, date of injury, and claim number. Incomplete forms may not be processed correctly, so take the time to double-check everything.
Another mistake people often make is not signing and dating the form. This step is crucial. Without a signature, the waiver cannot be considered valid. Both the injured worker and the employer must sign where indicated. If a representative is signing on behalf of either party, ensure that it is clearly noted that they are doing so at the direction of the party they represent. This clarity can prevent confusion down the line.
Many individuals overlook the requirement to submit the form to the correct customer service office. Each claim has a specific office where the form must be sent. Mailing or faxing the form to the wrong location can result in processing delays. Always verify the correct address or fax number for submission to ensure timely handling of your waiver.
Finally, some people misunderstand the implications of waiving their appeal rights. The waiver applies only to the specific order mentioned on the form, not to any past or future orders related to the claim. It's essential to understand that waiving the right to appeal one order does not affect your ability to appeal other orders. This distinction is crucial for anyone considering the waiver, as it can influence future decisions regarding the claim.
FAQ
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What is the C 108 Ohio form?
The C 108 Ohio form is a Waiver of Appeal Period form used in the context of Ohio workers' compensation claims. It allows parties involved in a claim, such as injured workers and employers, to waive their right to appeal certain orders issued by the Bureau of Workers' Compensation (BWC) and the Industrial Commission of Ohio (IC).
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Who needs to complete the C 108 form?
Both the injured worker and the employer may need to complete the form, depending on the specifics of the order. If the order allows for something other than compensation, both parties must sign the waiver. If the order pertains only to compensation and the employer is still in business, only the employer needs to sign. If the employer is out of business, the injured worker alone must submit the waiver.
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How do I submit the C 108 form?
You can submit the completed C 108 form by mailing or faxing a signed and dated copy to the customer service office where your claim is located. Additionally, the form can be filled out online at ohiobwc.com.
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What happens if I waive my right to appeal?
When you and the other party agree to waive your appeal rights, the appeal period for that specific order automatically expires. However, it is important to note that this waiver only applies to the order specified in the form. You retain the right to appeal other orders related to your claim.
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Can non-attorneys sign the C 108 form?
Yes, non-attorneys may sign the C 108 form, but only at the direction of the party they represent. They cannot sign the waiver independently. This ensures that the decision to waive the appeal is made with the consent of the involved parties.
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What is the significance of the mailing date on the form?
The mailing date specified on the C 108 form is crucial, as it marks the beginning of the appeal period. By waiving your right to appeal the order with this date, you are agreeing to accept the order as final.
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Are there any exceptions to waiving the appeal rights?
Yes, there are exceptions. For instance, if the employer is out of business, no waiver is needed for orders that allow only compensation. Additionally, the waiver must be specific to the order in question and does not apply to past or future orders affecting the claim.
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What should I do if I have further questions about the C 108 form?
If you have additional questions or need clarification regarding the C 108 form, it is advisable to contact the customer service office associated with your claim. They can provide specific guidance tailored to your situation.