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Forms and Motions

Ohio workers’ compensation requires the use of numerous forms for different types of requests.  Some common examples are listed below.  Click on the form name to download and print.  Requires free Adobe Reader (click here to download)

C9 Forms:

A C9 form is the form submitted by the physician to request approval for medical treatment.  The managed care organization (in state fund claims) or the self-insured employer makes the initial decision on the approval or denial of treatment.

C86 Motions:

A C86 motion is submitted whenever a request is made for issues such as additional conditions, adjustments in compensation rates, requests for new periods of temporary total disability, scheduled loss awards, etc.  (En Espaņol)

C84 Forms:

C84 forms are submitted to request temporary total disability compensation.  The front page of the form is completed by the injured worker.  The second page of the form is completed by the physician.  The Ohio BWC will not pay compensation unless both pages are complete.  

C92 Forms:

C92 forms are applications for permanent partial disability.  

C140 Forms:

C140 forms are used to request wage loss compensation.  The injured worker completes the first page and the physician completes the second page outlining the restrictions that prevent the injured worker from returning to his/her former position of employment.  

C141 Forms:

C141 forms are used to document job search efforts when requesting wage loss compensation. 

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Disclaimer:

The foregoing is not legal advice and should not be considered to be legal advice. These summaries are for general information only.  The summaries are incomplete and every workers’ compensation claim presents its own unique set of facts and application of the law. Please consult a qualified attorney for competent legal advice. 

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