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 This Request for Temporary Total Compensation C 84 is the Application You Complete to Request Temporary Total 2019-2025

C84 PDF 2019-2025 Form

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Understanding the C-84 Form for Temporary Total Compensation

The C-84 form is a critical document used in Ohio for requesting Temporary Total Compensation. This application is specifically designed for individuals who have sustained work-related injuries and are unable to return to work. By submitting the C-84 form, injured workers can seek financial support during their recovery period. It is essential to complete this form accurately to ensure timely processing and approval of benefits.

Steps to Complete the C-84 Form

Filling out the C-84 form requires careful attention to detail. Here are the key steps to ensure proper completion:

  • Begin by providing your personal information, including your name, address, and Social Security number.
  • Clearly state the date of your injury and the nature of your condition.
  • Indicate the duration for which you are requesting compensation.
  • Include any relevant medical documentation that supports your claim.
  • Review the form for accuracy before submitting it to avoid delays.

Legal Use of the C-84 Form

The C-84 form is legally binding and must be filled out in accordance with Ohio workers' compensation laws. To ensure its validity, the form must be signed and dated by the claimant. Additionally, it is important to comply with all guidelines set forth by the Ohio Bureau of Workers' Compensation (BWC) to prevent potential disputes or denials of benefits.

Eligibility Criteria for the C-84 Form

To qualify for Temporary Total Compensation using the C-84 form, applicants must meet specific eligibility criteria. These include:

  • Having a work-related injury that prevents them from performing their job duties.
  • Being under the care of a licensed medical professional who can provide documentation of the injury.
  • Filing the application within the designated time frame as outlined by the BWC.

Obtaining the C-84 Form

The C-84 form can be obtained through the Ohio Bureau of Workers' Compensation website or by visiting a local BWC office. It is important to ensure you are using the most current version of the form to avoid any issues during the submission process.

Form Submission Methods

Once the C-84 form is completed, it can be submitted in several ways:

  • Online through the BWC's official website, which allows for quick processing.
  • By mail, ensuring that it is sent to the correct address for the BWC.
  • In-person at a local BWC office, where assistance may be available if needed.

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