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 Release Medical
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 Temporary Total Compensation
Completion of a Motion
Use this form to file a motion.
Download: C-86 Motion
For the employer, unless the injured worker is self-employed or unemployed.
Download: Wages-EMP (Previously C-94)
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