Agreement To Select The State Of Ohio As The State Of Exclusive Remedy {BWC-1233}

BWC-1233 - EMPLOYER/EMPLOYEE AGREEMENT TO SELECT OHIO AS THE STATE OF EXCLUSIVE REMEDY FOR WORKERS’ COMPENSATION CLAIMS. An employee who enters into an employment contract outside of Ohio may work in another state some or all of the time. This leads to the possibility that Ohio’s workers’ compensation laws may conflict with those of the other state. In these cases, Ohio law allows employers and employees to choose workers’ compensation coverage from Ohio or from the other state. • Use this form to choose Ohio coverage. By signing this form, both the employee and employer agree to be bound exclusively by the workers’ compensation laws of Ohio. • Use form C-112 to choose coverage from a state other than Ohio. By signing that form, both the employee and employer agree to be bound exclusively by the workers’ compensation laws of the other state. Important notes: (1) Neither form C-110 nor C-112 can create jurisdiction where none exists. The forms merely clarify which state’s laws will apply in the event of a conflict between states having jurisdiction over an employer and employee. (2) Although BWC honors a valid C-110 in Ohio, the laws of another state might not recognize the terms of the agreement. Consult the workers’ compensation agency in the other state(s) or private counsel to verify the validity of this agreement outside Ohio. www.FormsWorkflow.com