Form C-140 (BWC-1267) Initial Application for Wage Loss Compensation - Ohio

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form C-140 (BWC-1267) for the current year.

Form C-140 (BWC-1267) Initial Application for Wage Loss Compensation - Ohio

What Is Form C-140 (BWC-1267)?

This is a legal form that was released by the Ohio Bureau of Workers' Compensation - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form C-140 (BWC-1267)?
A: Form C-140 (BWC-1267) is the initial application for Wage Loss Compensation in Ohio.

Q: What is Wage Loss Compensation?
A: Wage Loss Compensation is a benefit offered to workers who have suffered a permanent loss of earning capacity due to a work-related injury or occupational disease.

Q: Who can apply for Wage Loss Compensation?
A: Workers who have a permanent loss of earning capacity as a result of a work-related injury or occupational disease can apply for Wage Loss Compensation.

Q: What should I include in the application?
A: You should include detailed information about your injury or occupational disease, the impact it has had on your ability to earn a living, and any supporting medical documentation.

Q: What is the deadline for submitting the application?
A: The application must be submitted within two years from the date of the injury or the date on which you became aware of the occupational disease.

Q: What happens after I submit the application?
A: Once your application is received, the Ohio Bureau of Workers' Compensation will review the information provided, and if approved, you will begin receiving Wage Loss Compensation.

Q: How much Wage Loss Compensation will I receive?
A: The amount of Wage Loss Compensation you receive will depend on various factors, including the severity of your loss of earning capacity and your pre-injury or pre-occupational-disease wages.

ADVERTISEMENT

Form Details:

  • Released on May 13, 2014;
  • The latest edition provided by the Ohio Bureau of Workers' Compensation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form C-140 (BWC-1267) by clicking the link below or browse more documents and templates provided by the Ohio Bureau of Workers' Compensation.

Download Form C-140 (BWC-1267) Initial Application for Wage Loss Compensation - Ohio

4.3 of 5 (50 votes)
  • Form C-140 (BWC-1267) Initial Application for Wage Loss Compensation - Ohio

    1

  • Form C-140 (BWC-1267) Initial Application for Wage Loss Compensation - Ohio, Page 2

    2

  • Form C-140 (BWC-1267) Initial Application for Wage Loss Compensation - Ohio, Page 1
  • Form C-140 (BWC-1267) Initial Application for Wage Loss Compensation - Ohio, Page 2
Prev 1 2 Next
ADVERTISEMENT

Related Documents