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OhioBWC - Worker - Form: (C-92) - Introduction
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Application for Determination of Percentage of Permanent Partial Disability or Increase of Permanent Partial Disability
(C-92)
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| Introduction |
Injured workers should use this form to request a determination relative
to a permanent disability which they have as a result of their
work-related injury or disease. If there is any residual impairment,
the injured worker may be eligible for a monetary award based upon the
severity of the impairment. The injured worker may be eligible for this
benefit even if he or she did not lose time from work due to the injury.
The initial application for permanent partial disability (ppd) may be
submitted 40 weeks from the date of injury or 40 weeks after the last
date of temporary total disability compensation. In addition, an injured
worker can file for an increase in this benefit if the impairment becomes
more severe over time. There is no time constraint for filing for an
increase.
Authorized representatives: If you are submitting the C-92 on behalf
of an injured worker, and you also want to submit a power of attorney,
we must have the injured worker’s signature, whether electronic,
hard copy or on the Authorization to Receive Workers’ Compensation Check (C-230).
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| Required information |
- Claim number
- Type of application, i.e. initial percentage of permanent partial disability (%ppd), determination in the %ppd for a newly allowed condition, or increase in the %ppd
- County where injured worker resides
- Injured worker home and work telephone numbers
- Injured worker signature for authorization to disburse any monetary award (if applicable)
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| Complete the forms |
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Are you missing some of the required information? If so, you may return here at a later time when you have all the information you need, and complete this online form. Or, you may print a blank copy of the form to complete by hand and either mail or fax it to BWC.
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