Injured workers must use this form to initiate or extend payment of temporary total disability benefits.

For injured workers whose employer is self-insured: If your employer is self-insured, send the form to your employer. If you are not sure if your employer is a self-insuring employer, contact your …

One of a group of aggressive (fast-growing) non-hodgkin lymphomas that begin in mature t lymphocytes (t cells that have matured in the thymus gland and gone to other lymphatic sites …

Filling out the form C84 PDF with airSlate SignNow is straightforward. Simply upload the PDF to the platform, and use our easy editing tools to input the required information.

This Request for Temporary Total Compensation (C-84) is the application you complete to request temporary total disability benefits. You must complete the entire form and sign it.