OhioBWC - Common - Form:  (C-240) - Introduction

Settlement Agreement and Application for Approval of Settlement Agreement
(C-240)

Introduction
A settlement is an agreement between the employer, the injured worker, and BWC for a specific amount of money to settle one or more claims. When a claim is fully settled, the injured worker receives a lump sum payment. The injured worker will receive no additional compensation and/or benefits for the settled claim.
SPECIAL NOTICE TO MEDICARE BENEFICIARIES
Medicare does not pay medical bills for conditions covered by your workers' compensation claim. If a settlement of your workers' compensation claim is reached, and the settlement allocates certain amounts for future medical expenses (excluding amounts for prescription drugs), Medicare does not pay for those services until medical expenses related to your workers' compensation claim equal the amount of the lump sum settlement allocated to future medical expenses. For additional information, please call the Medicare Coordination of Benefits Contractor at 1-800-999-1118.
Required information
  • Claim number
  • Settlement amount
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