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Get OH BWC-1231 C-108 2012-2024

Mer service office where the claim is located. You may also complete this form online at ohiobwc.com. Claim Information Injured worker name Address Date of injury Claim number City State Nine-digit ZIP code City State Nine-digit ZIP code Employer name Address 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.

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