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How to fill out the Bwc 1235 Form online
The Bwc 1235 Form is used by employers and employees to select a state other than Ohio as the state of exclusive remedy for workers’ compensation claims. This guide provides clear, step-by-step instructions on how to complete this form online, ensuring users have a seamless experience.
Follow the steps to complete the Bwc 1235 Form online.
- Click ‘Get Form’ button to obtain the Bwc 1235 Form and open it in your preferred editing tool.
- Complete the employee approval section by providing the employee's first name, middle initial, last name, address, city, state, ZIP code, phone number, email, and signature.
- Fill in the employer approval section with the name of the employer, employer's BWC policy number, employer's address, city, state, ZIP code, and signature. Ensure an owner, partner, or officer of the organization signs this section.
- Include the state(s) in which the employee will work, as well as the state that will provide the coverage, ensuring it is not Ohio.
- Attach a certificate of coverage from the other state(s) to this form for validity.
- Confirm that an active Ohio workers’ compensation policy is maintained for the agreement to be valid.
- Review the entire form for accuracy and completeness prior to submission.
- Submit the completed form to BWC within 10 days of signing by faxing it to (614) 621-1435 or mailing it to BWC Policy Processing Dept., 30 W. Spring St., 22nd floor, Columbus, OH 43215.
- Once submitted, save changes to the form locally for your records and consider printing or sharing as needed.
Complete your Bwc 1235 Form online today to ensure your workers’ compensation coverage is correctly established.
For Ohio workers' compensation claims, you can contact the Bureau of Workers' Compensation at 1-800-644-6292. This contact can provide guidance on your claim process, including the use of necessary forms like the Bwc 1235 Form. Be sure to have your employer's information ready to speed up the process.
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