The C 230 Ohio form is an authorization document that allows an injured worker to designate their attorney to receive workers' compensation payments on their behalf. Completing this form accurately is essential, as it must be filed for each claim and application to ensure timely processing. Failure to adhere to the instructions may result in delays or denial of compensation payments.
The C 230 Ohio form serves as a crucial document for injured workers seeking to authorize the receipt of their workers' compensation payments. This form requires the injured worker's name, the attorney's name, the claim number, and a representative ID number. Completing the form accurately is essential; it must be filled out in its entirety, and each claim requires a separate authorization. The Bureau of Workers' Compensation (BWC) has specific guidelines regarding the timing of submissions, emphasizing that the form must be filed either before a hearing or prior to the payment date. For certain types of compensation, such as those related to permanent partial disability, the authorization must accompany the relevant application or agreement. The injured worker must also specify the type of compensation they are authorizing, which can include temporary total benefits, wage loss, or even death benefits. Importantly, this authorization does not grant the attorney the ability to cash or endorse checks on behalf of the injured worker. Once the BWC has made the payment as per the original application, the authorization ceases to be valid unless further actions, like hearings or appeals, occur. Furthermore, it is crucial to note that the authorization is only valid for 18 months from the date of the worker's signature. Understanding the nuances of the C 230 form is vital for ensuring a smooth process in receiving workers' compensation benefits.
Authorization to Receive Workers' Compensation Payment
Injured worker's name
Attorney's name
Claim number
Representative ID number
Instructions for completion
•You must complete this form in its entirety, including the correct claim number.
•You must file a separate authorization for each claim and for each application, motion or order.
BWC will not honor an authorization that is not completed in its entirety, is altered but not initialed by the party altering the form or is not timely filed.
Time limits for filing are as follows:
On all types of compensation, other than an application for the percentage of permanent partial compensation (C-92), you must file the authorization to receive workers’ compensation payment:
•Prior to or at the hearing;
•Prior to the date of the payment of compensation (before the award is issued) whether the award of compensation was made at a hearing or made without a hearing.
On any compensation paid pursuant to a C-92 application or an agreement of the parties to a percent permanent partial award, you must file the authorization:
•With the application or the agreement for permanent partial disability;
•With the application for the election of permanent partial from temporary partial;
•With the Industrial Commission of Ohio at the hearing;
•After the hearing but prior to the date of mailing of the hearing officer order.
I hereby authorize and direct BWC to mail directly to my attorney the compensation payment in the above numbered claim for the accrued portion of my award as specified below. You must specify the date of the application, request, motion or order.
Application, request, motion or order dated _____/_____/_____ for the type(s) of compensation listed below.
Check all that apply.
Temporary total
Impairment of earning capacity
Wage loss
Violation of specific safety
Change of occupation
Facial disfigurement
Scheduled loss
Lump sum settlement
Permanent total disability
Percentage permanent partial
Death benefits
Lump sum advancement
This authorization does not give my attorney the authority to cash or endorse a check on my behalf.
This authorization shall not continue in effect after BWC has paid said award(s) on the original application noted above unless there is a subsequent hearing, appeal or reconsideration after payment was made.
This authorization is not valid if it is filed beyond 18 months from the date of my signature.
Injured worker’s/claimant’s signature
Date
BWC-1360 (Rev. June 4, 2014)
C-230
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