OhioBWC - Worker - Form:  (C-92) - Introduction

Application for Determination of Percentage of Permanent Partial Disability or Increase of Permanent Partial Disability

Notice: We've temporarily disabled the online version of the C-92. We're working on revisions to the form that will better meet our customers' needs. In the meantime, please download and print the form and then fax it to BWC. Thank you for your patience.


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.

You may submit the initial application 40 weeks from the date of injury or 40 weeks after the last date of temporary total disability compensation. You can submit this form for an increase in this benefit if the impairment becomes more severe over time. There is no time constraint for filing for an increase.

Attention 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, you must obtain the injured worker's signature, whether electronic, hard copy or on the Authorization to Receive Workers' Compensation Check (C-230).

Required information
  • Type of application, i.e. initial percentage of permanent partial disability determination for a newly allowed condition, or an increase
  • County where injured worker resides
  • Injured worker home and work telephone numbers
  • Injured worker signature for authorization to disburse any monetary award (if applicable)

If you have all the required information on hand, simply click the start button to begin.