Get Ohio Bureau Of Workers'' Comp Form R 1

Filling out the Ohio Bureau Of Workers' Comp Form R 1 is an essential step for employers seeking to designate a representative for claims management. This guide provides clear instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to retrieve the form and open it for editing.
2. Enter the injured worker's name in the designated field. This should be the individual who has filed a claim.
3. Input the claim number associated with the injured worker's claim. This is crucial for form accuracy.
4. Fill in the date of injury in the specified format to ensure proper documentation.
5. Provide the Social Security number of the injured worker. This information is necessary for identity verification.
6. Enter the employer's name and corresponding policy number in their respective fields to identify the responsible party.
7. Input the complete employer address, including city, state, and ZIP code, to facilitate correspondence.
8. In the representative section, enter the representative's name and their valid Representative I.D. number. This ID confirms their authority.
9. Fill out the representative's address, telephone number, city, state, and ZIP code for communication purposes.
10. Provide the representative's email address and fax number to ensure that correspondence can be sent promptly.
11. Review the authorization statement carefully and confirm the acknowledgment that the representative may receive all correspondence related to the claim.
12. Have the employer official sign and date the authorization to validate the submission.
13. Once all fields are accurately completed, save your changes, and download, print, or share the form as needed.

Complete your forms online to ensure a smooth and efficient claims process.