Application for %PP (C-92)/Increase of %PP (C-92A)

The Application for Determination of Percentage of Permanent Partial Disability or Increase of Permanent Partial Disability is used to request a percentage of permanent partial impairment awards (C-92).  The C-92 application is available on COR under Percentage of Permanent Partial (C-92) Forms.

 

The C-92 form contains three check boxes to address percentage of permanent partial requests.  The injured worker will mark the check box that appropriately describes his/her request.  The first box is checked when the injured worker is requesting an initial percentage of permanent partial award (C-92) and no medical is required from the injured worker.  When this box is checked, the application will be entered in Application Tracking as a C-92.  Additional information regarding application tracking is available on COR under the Application Tracking policy.

 

The second box is checked when the injured worker is requesting a percentage of permanent partial award for a newly allowed condition and no new medical is required.  When this box is checked, the application will entered in Application Tracking as a C-92A.

 

The third check box is checked when the injured worker is requesting an increase of percentage of permanent partial award (C-92A) and requires that medical evidence that supports an increase over the previously granted percent of impairment be attached to the request.  When this box is checked, the application will be entered in Application Tracking as a C-92A.

 

*Note: Form C-92 may be filed electronically through Ohiobwc.com.

  However, the power of attorney (POA) on the application will not be honored unless BWC receives the injured worker’s signature on a copy of the electronic application, on a hardcopy application or via a completed and signed Authorization to Receive Workers’ Compensation Check (C-230) form.