Fill Out Your C 27 Form

What is the C-84 form used for?

The C-84 form is used to request Temporary Total Disability benefits. When an injured worker becomes unable to perform any work due to a work-related injury or illness, this form serves as the official application to receive compensation during the recovery period. Completing the entire form accurately is essential for processing the request.

Who is responsible for providing medical documentation?

The injured worker is responsible for securing supporting medical documents from their treating healthcare provider. This documentation should substantiate the period of disability being claimed. The MEDCO-14 form, or similar medical documentation, can be used to affirm the details provided in the C-84 form.

How often do I need to submit the C-84 form?

You must complete and submit the C-84 form each time you request an initial period of Temporary Total Compensation or an extension of an existing compensation period. Each application is treated distinctly, and supporting documentation must align with the designated request period.

Where do I file the C-84 form?

For injured workers employed by self-insured companies, the C-84 form should be sent directly to your employer. For those under other employers, you can complete the form online at www.bwc.ohio.gov. If you prefer to submit a hard copy, you can fax it to 1-866-336-8352 or mail it to the Bureau of Workers' Compensation (BWC) customer service office handling your claim.

What information is required in Section 1?

Section 1 of the C-84 form collects essential demographics about the injured worker. Details include your name, claim number, date of injury, address, and contact information. Providing a valid email address is optional but can facilitate easier communication with your claims specialist.

What should I include in the Disability Information section?

This section asks if you are applying for a new period of disability or an extension. If it's a new application, you must state the last day you worked. You will also need to list all healthcare providers currently treating you related to this claim. Accurate and comprehensive information here is crucial.

What happens if I provide false information on the C-84 form?

Providing false information or concealing relevant facts can lead to serious consequences, including felony criminal prosecution. This law underscores the importance of honesty when filling out the application. Signing the form means you affirm the truthfulness of your responses and understand the potential ramifications of fraud.

Can I receive benefits while working?

While receiving Temporary Total Compensation, you are not permitted to work. It is crucial to understand that engaging in any form of work while accepting these benefits may impact your eligibility and could lead to further legal consequences. Always be honest about your work status when filling out the C-84 form.

Filling out the C-27 form can seem straightforward, but many individuals encounter common pitfalls that can delay their benefits. One frequent mistake is incomplete personal information. It’s crucial to provide all requested demographics accurately, including your name, claim number, and current address. Failing to double-check this information can lead to delays in correspondence and misunderstandings regarding your claim.

Another common error occurs in Section 2, where applicants provide inadequate disability information. It’s essential to clearly indicate whether you are applying for a new period of disability or for an extension. Additionally, listing the last day you worked is vital, as is detailing all the medical providers treating your work-related injury. Missing this step can result in a rejection of your application or additional requests for information that could have been avoided.

Errors in the employment section often prove problematic, especially when applicants neglect to accurately describe their work situation. For example, clearly stating whether you have a job to return to or detailing any work you have had during the requested period of disability is necessary. Failing to do so might lead to complications in determining your eligibility for benefits or even refusal of your claim.

Many applicants also overlook the importance of detailing their benefits and earnings accurately in Section 5. If you have received any benefits such as unemployment or social security, this must be indicated, along with the necessary details. Omitting this information could lead to potential complications with your claim or an unfavorable review by the Bureau of Workers’ Compensation.

Finally, the signature section often becomes a source of confusion. Signatures must be provided in the correct manner, including dating the form. If you are unable to sign due to circumstances, ensure you mark the form and have a witness sign beside your mark, as neglecting this can invalidate your application. Each section of the C-27 form plays a key role, so attention to detail can make all the difference in receiving timely support during your disability period.

Alongside the C-84 form, there are various other documents that may be required during the claims process for Temporary Total Compensation. Each of these forms serves a specific purpose, and having them prepared can streamline the process for injured workers.

• MEDCO-14 Form: This is used to provide supporting medical documentation from the treating provider. It details the nature of the injury and justifies the request for temporary disability benefits.
• BWC-1 Form: This is the initial claim form that an injured worker files to report their injury to the Bureau of Workers' Compensation. It captures essential details about the incident and injury.
• BWC-120: This form allows the injured worker to request reimbursement for out-of-pocket medical expenses incurred due to the work-related injury.
• Notice of Appeal: In case of a disputed claim decision, this document is filed to formally communicate the injured worker’s intent to appeal the decision regarding their benefits.
• Eligibility Verification Form: This document confirms that the injured worker meets required criteria for benefits as specified by the BWC, ensuring their eligibility for compensation.
• Employers' Report of Injury (BWC-2): This form is submitted by the employer to report the accident and any relevant details about the injured worker’s employment and injury circumstances.
• Job Analysis Form: This form provides a detailed description of the injured worker's job duties, which helps in assessing their ability to return to work or need for modified duties.
• Vocational Rehabilitation Plan: Should an injured worker require further assistance with returning to work, this document outlines tailored training or job-seeking assistance to meet their needs.

Being familiar with these documents can significantly aid injured workers in understanding the steps required for filing their compensation claims and securing the necessary benefits. Ensuring all forms are accurately completed and submitted can help avoid unnecessary delays in receiving aid.

• C-84 (Request for Temporary Total Compensation): This form is specifically designed for injured workers to request temporary total disability benefits. It requires personal information, details about the disability, and signatures. Like the C-27, it focuses on securing the benefits needed for financial support during recovery.
• MEDCO-14 (Medical Status Report): This document is utilized to provide medical verification of a worker's disability status. Both the MEDCO-14 and C-27 require supporting medical documentation. They share a similar purpose in confirming the medical necessity behind claims for disability benefits.
• C-86 (Request for Compensation for Permanent Total Disability): Workers use this form to apply for permanent total disability benefits. Like the C-27, the C-86 also requires the injured worker to disclose personal and employment information. Both forms aim at helping ensure workers receive appropriate compensation according to their needs.
• C-3 (Claim for Compensation): This form initiates a claim following a work-related injury. Similar to the C-27, the C-3 gathers demographic and employment information necessary for processing claims. Both documents seek to facilitate the injured worker's access to compensation.

When filling out the C-84 form, consider the following do's and don'ts to ensure a smooth process.

• Do read all instructions carefully before beginning to fill out the form.
• Do provide accurate and complete information in every section.
• Don't forget to sign and date the form to verify your acknowledgment.
• Don't leave any required fields blank as this may delay processing.

The C-27 form, often surrounded by misconceptions, plays an important role in the process of claiming temporary total disability benefits. Understanding the truth behind common misunderstandings can help injured workers navigate this process more effectively.

• Misconception 1: The C-27 form and the C-84 form are the same.

While the C-27 form is often associated with temporary total disability claims, it serves a different purpose than the C-84. The C-84 is specifically used to request benefits, whereas the C-27 focuses more on reporting the details of the claim.

• Misconception 2: You don't need to provide supporting medical documentation.

Actually, it is crucial to secure necessary medical documentation from your treating provider. This information is required to support your claim and must be submitted alongside your application.

• Misconception 3: Once the C-27 form is submitted, it's not your responsibility to follow up.

This is inaccurate. After submitting the form, it remains your responsibility to ensure that it has been processed and that any additional information requested is provided timely.

• Misconception 4: You can file the C-27 form anytime without consequences.

There are specific timelines for submitting the form relative to your disability. Failing to adhere to these timelines could affect your eligibility for benefits.

• Misconception 5: All correspondence about your claim will be sent through email.

While providing an email address can facilitate communication, the Bureau of Workers’ Compensation (BWC) may still choose to send correspondence via traditional mail. Always ensure your mailing address is up-to-date.

• Misconception 6: Signing the form is just a formality.

Signing the C-27 form indicates that you have answered all questions truthfully and completely. Misrepresentations could lead to severe legal consequences.

• Misconception 7: Only self-insured employers require a different process.

This is misleading. While it’s true that self-insured employers handle claims differently, all injured workers must channel their claims through the proper processes established by the BWC.

• Misconception 8: You cannot apply for other benefits while waiting for C-27 processing.

Many injured workers might not realize that they can apply for other benefits, such as unemployment or disability payments, even as they await a decision on their temporary total compensation claim.

• Misconception 9: The form only has to be submitted once.

That is not correct. The C-27 form must be completed whenever there is a request for an initial period of benefits or for an extension of existing benefits. Each request necessitates a new submission.

• Misconception 10: You do not need to report all treating providers.

Reporting all treating providers is essential as the BWC needs complete information to understand your condition and determine the appropriate benefits. Omitting providers could jeopardize your claim.

When filling out the C 27 form to request temporary total disability benefits, consider these key takeaways:

• Complete Every Section: Ensure that you fill out every section of the form accurately. This includes providing your personal information and details about your disability.
• Document Your Condition: Obtain supporting medical documentation from your treating provider. Use the MEDCO-14 form or any equivalent documentation to substantiate your request.
• Sign the Form: Your signature on the form signifies that the information you have provided is truthful. If you are unable to sign, a witness must sign next to your mark.
• Understand Filing Procedures: Where you send the form depends on whether your employer is self-insured or not. Verify your employer's insurance status to avoid delays.
• Be Aware of Legal Consequences: Providing false information can lead to serious legal repercussions, including felony charges and penalties. Always provide honest and complete information.

By following these guidelines, you can navigate the C 27 form process more effectively and ensure a smoother application for your benefits.