Download: AC-2 Permanent Authorization

Authorization to Release Medical Information
Use this form to release your medical information to the Ohio Bureau of Workers’ Compensation (BWC), the Industrial Commission of Ohio, your employer, your employer’s managed care organization (or qualified health plan) and any other authorized representatives.
Download: C-101 Medical Release

Initial Application for Wage Loss Compensation
File this application when requesting an initial payment of wage-loss compensation.
Download: C-140 Wage Loss

Notice to Change Physician of Record
Use this form to change your physician.
Download: C-23 Change Physician

Request for Temporary Total Compensation
Use this form if you are an injured worker who wishes to request total compensation on a temporary basis.
Download: C-84 Request for TT

Completion of a Motion
Use this form to file a motion.
Download: C-86 Motion

Wage Statement
For the employer, unless the injured worker is self-employed or unemployed.
Download: C-94-A Wage Statement

Physician’s Request
For physicians, when they need to request medical services or recommend additional conditions for industrial injury or occupational disease.
Download: C-9 Physician’s Request

First Report of an Injury, Occupational Disease or Death
Download: FROI