Get Form Oic-wc-2

Filling out the Form OIC-WC-2 is an important step in reporting an occupational injury or disease. This guide provides a comprehensive overview of the form's structure and offers clear instructions to assist users in completing it accurately.

Follow the steps to complete the Form OIC-WC-2 online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by entering the employer information in Section I. Fill in the insurer, third-party administrator, employer's name, nature of business, FEIN, address, city, state, and zip code.
3. In Section II, provide the employee information. Include the employee's name (last, first, middle initial), occupation or job title, address, telephone number, city, state, date of birth, sex, and check the applicable boxes regarding their employment status (full-time, part-time, etc.).
4. Next, fill out Section III which pertains to information regarding the injury or disease. Input the date and time of the injury or last exposure, the date the employer was notified, the supervisor's name, and if applicable, the date of death if the injury was fatal.
5. Detail the specifics of the injury. Indicate whether the injury occurred on employer property, list witnesses, and provide a location description. Describe what the employee was doing at the time of the injury and how the injury occurred.
6. In Section IV, fill out the wage and lost time information. Include the date hired, last day worked after the injury, the date of return to work, the number of workdays lost, and whether light duty is available.
7. Provide the wage details on the date of injury, including the hourly rate and the number of hours worked per week. Indicate if wages are being paid during disability and the current wage if the employee has returned to modified work.
8. Conclude by certifying the accuracy of the statements made on the form. Print your name, sign, include your title, and date the form appropriately.
9. Once all sections are completed, you can save changes, download, print, or share the form.

Complete the Form OIC-WC-2 online to ensure proper reporting of occupational injuries or diseases.