Acknowledgment Of The Self Insured Joint Settlement {BWC-7243}

BWC-7243 -- ACKNOWLEDGMENT OF THE SELF-INSURED JOINT SETTLEMENT. This form is used in the Bureau of Workers' Compensation and is an acknowledgment form that injured workers must sign after their attorney has explained all aspects of the settlement application/agreement with the self-insured employer. By signing this form, the injured worker acknowledges several key points, including their understanding that they will not receive future compensation or benefits outlined in the settlement agreement, that any settlement amount may be subject to court-ordered child support payments, and that they may be responsible for attorney fees. The form must be attached to the Self-insured Joint Settlement Agreement and Release and filed at the nearest regional office of the Industrial Commission of Ohio (IC). www.FormsWorkFlow.com