The C 108 Ohio form is a critical document used in Ohio's workers' compensation system, allowing parties involved in a claim to waive their right to appeal certain orders. By completing this form, injured workers and employers can expedite the process and move forward without the delay of an appeal period. Understanding how to properly fill out and submit the C 108 form is essential for ensuring that your rights and interests are protected in the claims process.
The C 108 Ohio form plays a crucial role in the workers' compensation process by allowing parties involved in a claim to waive their right to appeal certain orders issued by the Bureau of Workers' Compensation (BWC) and the Industrial Commission of Ohio (IC). This form must be completed with care, as it requires specific information about the injured worker, the employer, and the details of the claim, including the date of injury and claim number. It's essential that all applicable sections are filled out accurately, as this form can be submitted either by mail or fax to the appropriate customer service office, or conveniently completed online at ohiobwc.com. Understanding when and how to use the C 108 form is vital; for example, if an order includes allowances beyond just compensation, both the injured worker and employer must sign the waiver. Conversely, if the order pertains solely to compensation, only the employer's signature is necessary, unless they are out of business. The waiver must be signed by the injured worker, employer, or their authorized representatives, with specific rules governing who can sign on behalf of whom. Importantly, waiving the right to appeal applies only to the particular order specified and does not affect the ability to appeal future orders related to the claim. This form is a key component in streamlining the claims process and ensuring all parties are in agreement regarding their rights to appeal.
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
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
I am a non-attorney representative for the employer who is signing at the direction of the employer.
BWC Administrator/Authorized representative
May only waive appeal rights to IC orders.
BWC-1231 (Rev. 4/17/2012)
C-108
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