Quick Links
If you are a new Bureau of Workers' Compensation ("BWC") client, please call our office after you print the following documents (please do not complete or sign any of the documents until you have spoken with our office):
Workers' Compensation Questionnaire
Medical Authorization
First Report of Injury ("FROI")
Injured Worker Authorized Representative ("R-2")
Request for Temporary Total Compensation ("C-84")
Wage Statement ("C-94-A")
Application for Permanent Partial Disability ("C-92")
Authorization to Receive Check ("C-230")
Request for Medical Information ("C-30")
2012 Compensation Rate Chart
If you are a new Ohio Police & Fire Disability Retirement ("OP&F") client, please call our office after you print the following documents (please do not complete or sign any of the documents until you have spoken with our office):
Designation of Agent
Disability Benefit Application
Authorization to Release Medical Records
Authorization to Release Records
Annuity Payment Plan Selection
Designation of Beneficiary for $1,000 Lump Sum Death Benefit
Direct Deposit Application
Federal W-4 Form
Withholding for Ohio State Income Tax
Internal Revenue Service - Private Letter Ruling
If you are a new Ohio Public Employees Retirement System ("OPERS") client, please call our office after you print the following documents (please do not complete or sign any of the documents until you have spoken with our office):
Disability Benefit Application
Report of Attending Physician
Authorization to Release Information
If you are a new Ohio Victims of Crime ("VOC") client, please call our office after you print the following documents (please do not complete or sign any of the documents until you have spoken with our office):
Compensation Application
Supplemental Application