Instructions. • You must file this form when requesting a settlement if you are an injured worker receiving permanent total disability (PTD). Instructions. • You must file this form when requesting a settlement if you are an injured worker applying for an indemnity only settlement.If your application is approved, you are likely to receive 1020 percent of your expected settlement. Everything You Need to Know About Ohio Workers' Comp Settlements. For More Information, Call Attorney Mark L. Newman at 513-533-2009. How do I fill out the claim form? This article provides a template for a debt settlement proposal letter and explains what a debt settlement letter should contain. Edit your loan settlement confirmation letter online. Type text, add images, blackout confidential details, add comments, highlights and more. Forms downloaded from the Court's web pages are fillable PDFs and MUST be typed complete with signatures.