Form C-59 (BWC-1177) Self-insurers' Agreement as to Compensation on Account of Death - Ohio

Form C-59 (BWC-1177) Self-insurers' Agreement as to Compensation on Account of Death - Ohio

What Is Form C-59 (BWC-1177)?

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-59?
A: Form C-59 is the Self-insurers' Agreement as to Compensation on Account of Death in Ohio.

Q: What is BWC-1177?
A: BWC-1177 is the form number assigned to Form C-59.

Q: Who is required to fill out Form C-59?
A: This form is to be completed by self-insured employers in Ohio.

Q: What is the purpose of Form C-59?
A: Form C-59 is used to report compensation on account of death related to work-related injuries or illnesses.

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Form Details:

  • Released on March 1, 2005;
  • 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-59 (BWC-1177) by clicking the link below or browse more documents and templates provided by the Ohio Bureau of Workers' Compensation.

Download Form C-59 (BWC-1177) Self-insurers' Agreement as to Compensation on Account of Death - Ohio

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