The Ohio OS-24 form serves as a comprehensive list of available forms and publications related to workers' compensation services in Ohio. This essential resource helps individuals and businesses navigate the various forms needed for claims, medical documentation, and other related processes. For those looking to fill out the form, click the button below to get started.
The Ohio OS-24 form serves as a crucial resource for individuals and businesses navigating the workers' compensation system in Ohio. It provides a comprehensive list of available forms and publications related to workplace injuries, medical treatments, and compensation claims. Users can find essential documents such as the Temporary Authorization (AC-3), Physician’s Report (C-9), and various applications for benefits, including wage loss compensation (C-140) and lump sum advancements (C-32). Additionally, the OS-24 form outlines important contact information, including the Ohio Bureau of Workers' Compensation's address and phone number, ensuring that users can easily access assistance. It is vital to note that all submissions must include a physical address, as deliveries cannot be made to P.O. boxes. This form is not only a guide to the necessary paperwork but also a gateway to understanding the rights and responsibilities associated with workers' compensation in Ohio.
OFfiCE SERVICES FORMS & PUBLICATIONS 3655 Brookham Drive Grove City, Ohio 43123
Call: 1-800-OHIOBWC, and listen to the options Fax: 614-621-5746
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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.
Once you have gathered all necessary information, you can proceed to fill out the Ohio OS-24 form. This form is primarily used to request various forms and publications related to workers' compensation. Ensure that all information is accurate and complete before submitting.
The Ohio OS-24 form is a list of available forms and publications related to workers' compensation services in Ohio. It helps individuals and companies find the necessary documents they need for various claims and processes.
You can obtain the OS-24 form by contacting the Ohio Bureau of Workers' Compensation (BWC). Call 1-800-OHIOBWC and follow the options provided. Alternatively, you can visit their office at 3655 Brookham Drive, Grove City, Ohio.
The OS-24 includes a variety of forms related to workers' compensation, such as:
These forms cover different aspects of workers' compensation claims, including medical documentation and wage loss requests.
The OS-24 form itself is not submitted online. Instead, it serves as a reference for obtaining other forms. Most forms listed can be requested through the BWC, but check their website for any online submission options for specific forms.
When requesting forms, provide your physical address, customer ID number, contact name, telephone number, company name, email address, and the specific forms you need. Ensure that you do not use a P.O. Box for delivery, as the BWC cannot ship to those addresses.
Yes, forms that are not listed on the OS-24 are not available through the BWC. If you need forms from the Industrial Commission of Ohio, you can call them directly at 614-644-8009 for assistance.
The publications listed on the OS-24 provide important information regarding workers' compensation, including guidelines on medical necessity and fraud prevention. They help ensure that individuals and employers are informed about their rights and responsibilities.
Using a P.O. Box Address: The form requires a physical address for delivery. Submitting a P.O. Box can lead to rejection or delays.
Incomplete Customer Information: Failing to fill in the Customer ID number, contact name, or telephone number can result in processing issues.
Incorrect Form Selection: Choosing the wrong form number or title can lead to delays in receiving the appropriate services or benefits.
Neglecting to Sign: Not signing the form where required can invalidate the submission and cause unnecessary delays.
Omitting Required Documentation: Forgetting to include necessary documents, such as medical reports or proof of injury, can hinder the processing of claims.
Providing Inaccurate Contact Information: An incorrect email address or phone number can result in missed communications regarding the status of the application.
Failing to Check for Updates: Not reviewing the latest version of the form or any changes to the submission process can lead to errors in filling out the form.
Ignoring Submission Guidelines: Not adhering to the specified submission methods, such as faxing or mailing, can result in the form not being processed.
Overlooking Deadlines: Missing submission deadlines can jeopardize eligibility for benefits or services, leading to further complications.
When dealing with workers' compensation in Ohio, the Ohio OS 24 form is just one piece of the puzzle. Several other forms and documents often accompany it to ensure that all necessary information is collected and processed efficiently. Below is a list of important forms that you may encounter in conjunction with the Ohio OS 24 form.
Understanding these forms can significantly streamline the workers' compensation process in Ohio. Each document serves a specific purpose, ensuring that both workers and employers are protected and informed throughout the claims process. Familiarizing yourself with these forms can help you navigate the system with greater ease.
The AC-3 form, known as Temporary Authorization, is similar to the Ohio OS-24 form in that it allows individuals to provide temporary consent for specific actions related to workers' compensation claims. Both forms are used to facilitate communication and processing of claims, ensuring that the necessary authorizations are in place for medical treatment or other services. The AC-3 form specifically focuses on temporary permissions, while the OS-24 serves as a broader resource for various forms and publications related to workers' compensation.
The C-5 form, titled Additional Information for Death Benefits, also shares similarities with the Ohio OS-24 form. Both documents are integral in the workers' compensation process, particularly in cases involving death benefits. The C-5 form gathers essential information needed to process claims for benefits related to a deceased worker, while the OS-24 form provides access to a range of forms and publications that can assist in navigating the overall claims process.
The C-9 form, which is a Physician’s Report/Treatment Plan for Industrial Injury or Occupational Disease, is another document related to the Ohio OS-24 form. This form is crucial for obtaining medical evaluations and treatment plans necessary for claims. Like the OS-24, the C-9 form plays a role in ensuring that the injured worker's medical needs are documented and addressed, thereby facilitating the claims process.
Another relevant form is the C-11, which is a Request to Appeal MCO Medical Treatment/Service Decision. This form is used when an injured worker wishes to contest a decision made by a Managed Care Organization regarding their treatment. Similar to the OS-24 form, the C-11 supports the claims process by providing a structured way to address disputes and seek further review of treatment decisions.
The C-32 form, Application for Lump Sum Advancement, is comparable to the Ohio OS-24 form in that it deals with financial aspects of workers' compensation. The C-32 form allows individuals to request an advance on their benefits, while the OS-24 provides a comprehensive list of forms and resources that can assist in managing various aspects of a claim, including financial requests.
The C-84 form, which is a Request for Temporary Total Compensation, is another document that aligns with the Ohio OS-24 form. Both forms are utilized in the context of claims related to temporary disability. The C-84 specifically requests compensation for a period of temporary total disability, while the OS-24 serves as a guide to various forms that may be needed throughout the claims process.
The C-140 form, Application for Wage Loss Compensation, is similar to the Ohio OS-24 form as it addresses financial support for injured workers. The C-140 form allows workers to apply for compensation related to lost wages due to injury, while the OS-24 provides access to a range of related forms and resources that can help workers navigate their claims effectively.
The FROI-1 form, or First Report of Injury, Occupational Disease or Death, is essential in initiating the claims process. It is similar to the Ohio OS-24 form in that it serves as a foundational document for workers' compensation claims. The FROI-1 captures critical information about the injury or illness, while the OS-24 offers a comprehensive overview of available forms and resources that support the ongoing claims process.
The MEDCO-14 form, Report of Work Ability, is another document that shares similarities with the Ohio OS-24 form. This form is used to report an injured worker's ability to return to work after an injury. Both the MEDCO-14 and the OS-24 form contribute to the overall management of workers' compensation claims by ensuring that relevant medical information is communicated effectively.
Lastly, the U-3 form, Application for Ohio Workers’ Compensation Coverage, is relevant as it establishes coverage for workers under Ohio's workers' compensation system. Like the Ohio OS-24 form, the U-3 form is a critical component in the claims process, ensuring that workers are properly covered and that their claims can be processed efficiently.
When filling out the Ohio OS-24 form, it's important to follow certain guidelines to ensure your submission is accurate and complete. Here are five things you should and shouldn't do:
This form actually serves as a comprehensive list of various forms and publications related to the Bureau of Workers' Compensation (BWC) in Ohio. It includes forms for medical reports, wage loss compensation, and more.
Due to shipping regulations, the BWC requires a physical address for delivery. This means P.O. Boxes cannot be used for submissions.
While the OS 24 form provides a list of available forms, not all may be accessible online. Some may require a call to the BWC or the Industrial Commission of Ohio for access.
Employers, medical providers, and other stakeholders can also benefit from the information on the OS 24 form. It includes forms relevant to various parties involved in the workers' compensation system.
The OS 24 form is not a request form itself. Instead, it serves as a guide to help individuals identify which forms they may need to complete and submit separately.
In addition to the OS 24 form, individuals can access other resources, such as the BWC website or the Industrial Commission of Ohio, for more detailed information.
The form is periodically revised, but users should always check the date on the form to ensure they have the most current information available.
The OS 24 form can be accessed online, making it easier for individuals to find the information they need without visiting the office in person.
When filling out the Ohio OS-24 form, consider the following key points: