Workers Compensation Claim Form. Be sure to sign and date the claim form and keep a copy for your records. Formularios para Trabajadores - en Espaol.
How to fill out a claim form. Aug 31 2020 Form name Version date Notes. The Managed Care Organization will file the initial claim information and medical documentation with the Ohio Bureau of Workers Compensation.
Use the saved form as a template for future.
Save the form onto your computer by hitting Save As. Jun 30 2020 Ohio workers who are injured on the job can request wage replacement and medical benefits by filing a workers compensation claim. Waiver of Workers Compensation Benefits for Recreational or Fitness Activities. Gather all necessary information Complete as many fields with as much detail as you can.
