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This version of the form is not currently in use and is provided for reference only. Download this version of
Form C-110 (BWC-1233)
for the current year.
Form C-110 (BWC-1233) Employer / Employee Agreement to Select Ohio as the State of Exclusive Remedy for Workers' Compensation Claims - Ohio
What Is Form C-110 (BWC-1233)?
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-110 (BWC-1233)?
A: Form C-110 (BWC-1233) is an Employer/Employee Agreement to Select Ohio as the State of Exclusive Remedy for Workers' Compensation Claims.
Q: What is the purpose of Form C-110 (BWC-1233)?
A: The purpose of Form C-110 (BWC-1233) is to establish Ohio as the exclusive state for handling workers' compensation claims for both the employer and employee involved.
Q: Who should fill out Form C-110 (BWC-1233)?
A: Both the employer and employee should fill out Form C-110 (BWC-1233) to select Ohio as the state of exclusive remedy for workers' compensation claims.
Q: Why would an employer and employee choose Ohio as the exclusive state for workers' compensation claims?
A: There can be various reasons for choosing Ohio as the exclusive state for workers' compensation claims, such as residency in Ohio or the location of the employer's principal place of business in Ohio.
Form Details:
- Released on April 27, 2009;
- 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-110 (BWC-1233) by clicking the link below or browse more documents and templates provided by the Ohio Bureau of Workers' Compensation.
