Get Oh Ic 12 2017-2025

The OH IC 12 form is essential for submitting a notice of appeal regarding workers' compensation cases. This guide will provide user-friendly, step-by-step instructions to assist you in accurately completing the form online.

Follow the steps to successfully complete the OH IC 12 form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the claim number at the top of the form to reference the specific case associated with your appeal.
3. Fill in the injured worker information including their name, address, city, state, zip code, telephone number, and fax number.
4. Complete the employer information section with the employer's name, address, city, state, zip code, telephone number, and fax number.
5. Provide the representative information for both the injured worker and the employer, including their names, rep IDs, telephone, and fax numbers.
6. Record the hearing date and location, including the city and the date the order was received in the specified format (mm/dd/yyyy).
7. Indicate whether you have filed or intend to file new evidence not available at the last hearing by selecting 'Yes' or 'No.'
8. If you are a self-insuring employer, confirm whether compensation or benefits have been or will be paid timely according to R.C. 4123.511.
9. If necessary, request an interpreter or court reporter by checking the corresponding boxes and indicating the language needed for the interpreter.
10. Certify that you have mailed copies of the notice to the appropriate representatives or individuals by checking the appropriate options and providing the date.
11. Finally, sign the form as the appellant, ensuring that all information is correct and complete.
12. Once completed, save your changes to the form, and consider downloading, printing, or sharing it as needed.

Start filling out your OH IC 12 form online today for timely resolution of your appeal.