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Last updated: 10/25/2023
Application For Determination Of Percentage Of Permanent Partial Disability {BWC-1214}
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Description
BWC-1214 - APPLICATION FOR DETERMINATION OR INCREASE OF PERCENTAGE OF PERMANENT PARTIAL DISABILITY (C-92). This form is used by injured workers to apply for the initial percentage of permanent partial disability (%PPD), request %PPD for a newly allowed condition, or seek an increase in the %PPD due to worsened medical conditions. The form includes personal information, details about the injury, preferred contact methods, and exam availability. The injured worker must sign the form, certifying its accuracy, and can authorize the compensation payment to be mailed directly to their attorney. Failure to attend scheduled exams or respond to exam scheduling attempts may result in the application being dismissed. www.FormsWorkflow.com