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")
- Physician's Report of Work Ability ("MEDCO-14")
- Wage Statement ("C-94-A")
- Application for Permanent Partial Disability ("C-92")
- Authorization to Receive Check ("C-230")
- 11/03/1989 to 12/31/2016 Compensation Rate Chart
- 11/02/1959 to 11/02/1989 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 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):
