Get Ohio Bwc C240 Form

The Ohio Bwc C240 form is essential for applying for the approval of a final settlement agreement related to workers' compensation claims. This guide aims to provide a clear and concise method for filling out the form online, ensuring that all necessary information is accurately submitted.

Follow the steps to complete the Ohio Bwc C240 Form online.

1. Click the ‘Get Form’ button to retrieve the Ohio Bwc C240 Form and open it for editing.
2. Enter the injured worker's name, Social Security number, and address in the designated fields.
3. Include the injured worker's date of birth along with their representative's information if applicable.
4. Fill in the employer's name, risk number, and contact information, ensuring all fields are accurate.
5. List claim numbers and specify the requested settlement amounts for each claim in the appropriate sections.
6. Provide details regarding the allocation of the requested settlement amount across indemnity, prescription drugs, and medical expenses.
7. Clearly justify the reasons for proposing the settlement, mentioning any significant circumstances that support your request.
8. Check the relevant boxes regarding ongoing medical treatment and Medicare benefits, as required.
9. Obtain the necessary signatures, including that of the employer, if required by state regulations.
10. Review the completed form for accuracy, then save the changes, and prepare to download, print, or share the form as needed.

Complete your Ohio Bwc C240 Form online today for a streamlined settlement process.