Get Oh Bwc 1174 2008-2025
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How to fill out the OH BWC 1174 online
The OH BWC 1174 form is crucial for acknowledging an agreement regarding salary continuation in lieu of temporary total or living maintenance compensation. This guide provides clear, step-by-step instructions to help you complete this form online accurately and efficiently.
Follow the steps to fill out the OH BWC 1174 form online
- Press the ‘Get Form’ button to access the form and open it in your preferred editor.
- Begin by entering the employee's name and the employer's name in the designated fields.
- Fill in the claim number and policy number, ensuring these details are accurate.
- Provide the employer's telephone number to facilitate any necessary communication.
- Date the agreement by filling in the day, month, and year in the appropriate section.
- State the date of the employee's accident or occupational disease in the format of month/day/year.
- Indicate the amount of salary continuation to be paid per designated period (weekly, bi-weekly, etc.) and fill in the start and end dates of the payment period.
- Answer whether the amount paid includes salary/wages from other employment by selecting 'Yes' or 'No'.
- Review the instructions for submitting a new C-55 and the requirements for notifying BWC if salary continuation changes.
- Lastly, both the employee and employer must sign and date the agreement to finalize the form.
Complete your OH BWC 1174 form online today to ensure proper processing of your salary continuation agreement.
The BWC process in Ohio involves submitting a claim for workers' compensation when you experience an injury or illness at work. First, you report your injury to your employer, then they file the necessary paperwork with the Ohio Bureau of Workers' Compensation (BWC). The BWC will review your claim and determine eligibility for benefits. Understanding this process is crucial for navigating your rights effectively under the OH BWC 1174 program.
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