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Records in the space indicated on this form. Please sign and date the form, and send it to the customer service office where your claim is located or to your self-insured employer. C-101 - Authorization to Release Medical Information: Injured workers should use this form to authorize the release of medical records relative to their work-related injury(s). By signing this form, the injured worker authorizes medical providers who have rendered services relative to the injury to release inform.

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(B) An employee may waive the employee's rights to compensation or benefits as authorized pursuant to division (C)(3) of section 4123.01 or section 4123.15 of the Revised Code.

If you're updating the existing policy, complete both forms: Notification of Policy Update (U-117) and Notification of Purchase/Sale or Merger/Acquisition (U-118). You must obtain authorization from the former owner on the U-118 to process and update.

For injury or occupational disease claims with injury or diagnosis dates on or after August 25, 2006, the claim is considered to be a 5-year claim and is open for 5 years from the date of the last compensation or the last payment of a medical bill, whichever is later.

In Ohio, any business with employees, even a single employee, is required to carry Workers' Compensation coverage. However, a sole proprietor, sole proprietor operating as an LLC, or partner in a business is NOT required to participate in the Ohio Workers' Compensation program.

Call 1-800-644-6292, listen to the options to reach a customer service representative. You can dial the number nationwide, and in Canada and Mexico from 7:30 a.m. to 5:30 p.m. EST. Remember, you can access information and request services by visiting BWC's website at bwc.ohio.gov.

While Ohio employers can fire workers “at will,” they cannot fire someone in retaliation for filing for workers' compensation.

Submit requests and inquiries to: 26th floor Columbus, Ohio 43215 Phone: 614-752-9147 | Fax: 614-621-9454 Email: publicrecords@bwc.state.oh.us In the spirit of open government, the Ohio Bureau of Workers' Compensation (BWC) complies with the Ohio Public Records Act, set forth in Section 149.43 of the Ohio Revised Code.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232