The Ohio OS-24 form serves as a comprehensive list of forms and publications available through the Bureau of Workers' Compensation (BWC) in Ohio. This form is essential for individuals and businesses navigating the workers' compensation system, providing access to necessary documentation for various processes. Understanding the OS-24 form can streamline your experience when dealing with workers' compensation claims and related issues.
The Ohio OS 24 form serves as a comprehensive resource for individuals and organizations seeking various forms and publications related to workers' compensation and safety in Ohio. This form facilitates the request for a wide array of documents, including temporary authorizations, medical reports, and applications for wage loss compensation. Users can find specific forms such as the C-5 for additional information on death benefits and the C-84 for temporary total compensation requests. Additionally, the OS 24 form outlines the necessary contact information required for processing, including the customer's ID number, company name, and physical address, as deliveries cannot be made to post office boxes. It also provides a list of available publications, such as fraud brochures and safety posters, which are essential for maintaining compliance and awareness. The form emphasizes the importance of proper documentation and communication in the workers' compensation process, ensuring that all parties have access to the necessary tools for effective management of claims and benefits.
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Date
Customer ID number
Contact name
Telephone number
Company name
Email address
Address
City
State
ZIP code
FORMS AVAILABLE
Quantity Form no.
Title
AC-3
Temporary Authorization
C-5
Additional Information for Death Benefits
C-9
Physician’s Report/Treatment Plan for Industrial
Injury or Occupational Disease
C-9A
Request for Additional Medical Documentation for C-9
C-11
Request to Appeal MCO Medical Treatment/
Service Decision
C-17
Pharmacy Invoice
C-18
Wage Agreement
C-19
Service Invoice
C-23
Change of Doctor Request
C-32
Application for Lump Sum Advancement
C-44
Physician’s Certificate in Proof of Death
C-58
Application for Adjustment of Claim in Case of Fatal
Injury
C-59
Self-Insurer’s Agreement as to Compensation on
Account of Death
C-60
Injured Worker Statement for Reimbursement of Travel
Expense
C-77
Injured Workers’ Change of Address
C-84
Request for Temporary Total Compensation
C-86
Motion
C-92
Application for Determination of the Percentage of
Permanent Partial Disability or Increase of Permanent
Partial Disability
C-94A
Wage Statement
C-101
Authorization to Release Medical Information
C-108
Request for Waiver of Appeal
C-110
Agreement to Select The State of Ohio as the
State of Exclusive Remedy
C-112
Agreement to Select a State Other than Ohio as
the State of Exclusive Remedy
C-140
Application for Wage Loss Compensation
C-141
Wage Loss Statement for Job Search
C-143
DEP Physician’s Report of Work Ability
C-159
Waiver of Workers’ Compensation Benefits for
Recreational or Fitness Activities
Quantity
Form no.
C-190
Justification of Medical Necessity for Seating/
Wheeled Mobility
C-230
Authorization to Receive Workers’ Compensation
Check
C-240A
Notice of Exception to Employer’s
Signature Requirement
C-240
C-241
Amended Settlement Agreement and Release
CHP-4A
Application for Handicapped Reimbursement
FROI-1
First Report of Injury, Occupational Disease or Death
MEDCO-13
Application for Provider Enrollment and Certification
MEDCO-13A
Application for Provider Enrollment-Non Certification
MEDCO-14
Report of Work Ability
R-1
Authorization of Representative of Employer
R-2
Authorization of Representative of Injured Worker
RH-1
Rehabilitation Agreement
RH-2
Individualized Vocational Rehabilitation Plan
RH-5
Trainer’s Report
RH-6
On-The-Job Training Agreement
RH-7
Loan/Lease Agreement for Tools and Equipment
RH-10
Injured Worker’s Record of Job Search Contacts
RH-18
Authorization for Living Maintenance Wage Loss (LMWL
RH-19
Employer Incentive Contract
RH-21
Vocational Rehabilitation Closure Report
RH-24
Gradual Return to Work Contract Employer
Reimbursement Method
SI-28
Filing of an Allegation Against a Self-Insured Employer
SI-42
Self-Insured Joint Settlement Agreement and Release
SI-43
Acknowledgment of the Self-Insured Joint
Settlement Agreement and Release
U-3
Application for Ohio Workers’ Compensation Coverage
U-3S
Application for Optional Supplemental Coverage
U-117
U-118
Notification of Business
Acquisition/Merger or Purchase/Sale
BWC-5026 (REV. 12/03/2013)
OS-24
PUBLICATIONS AVAILABLE
Form number
CD 106
BWC Medical Guide
FB
Fraud Brochure
FBLW
Fraud Brochure Law
FBMCO
Fraud Brochure MCO
FBSI
Fraud Brochure Self Insured
FFFI
Fraud Flyer Financial
FFPH
Fraud Flyer Pharmacy
FP 01
Fraud Poster
FS 01
Fraud Sticker
Forms & Publications List
PERRP
Safety and Health Protection on the Job Poster
Prepared by
Agent number
Initials
Forms that are not listed here are not available through BWC office services forms and publications.
You may obtain Industrial Commission of Ohio (IC) forms by calling the IC forms and
publications number at 614-644-8009.
Ohio Lost Money - Completion of this document is the first step in potentially recovering assets from dormant accounts.
Ohio School Tax - Key instructions include correctly identifying counties of taxable sales through designated codes available on the Ohio Department of Taxation website.