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Content Overview

The Ohio OS-24 form serves as a comprehensive resource for individuals and businesses seeking various forms and publications related to workers' compensation and safety in Ohio. This form includes essential information such as the customer ID number, contact details, and physical address, which is crucial for processing requests. Notably, it outlines a wide array of available forms, including applications for wage loss compensation, requests for medical documentation, and reports of work ability. Additionally, the OS-24 form provides access to important publications, such as fraud brochures and safety posters, aimed at educating stakeholders about their rights and responsibilities. Users must note that certain forms are not available through the Bureau of Workers' Compensation (BWC) and should contact the Industrial Commission of Ohio for those specific needs. By centralizing this information, the OS-24 form streamlines the process for obtaining necessary documentation and enhances compliance with Ohio’s workers' compensation regulations.

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Date Customer ID number Contact name Telephone number
Company name Email address
Address City State ZIP code
BWC-5026 (Rev. 12/03/2013)
OS-24
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. Title
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 Notice of Exception to Employer’s
Signature Requirement
C-241 Amended Settlement Agreement and Release
CHP-4A Application for Handicapped Reimbursement
FROI-1 F
irst 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 Application for Optional Supplemental Coverage
U-118 Notification of Business
Acquisition/Merger or Purchase/Sale
Forms available
Office Services Forms & Publications
3655 Brookham Drive
Grove City, Ohio 43123
Call: 1-800-OHIOBWC, and listen to the options
Fax: 614-621-5746
Publications available
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.
Prepared by
Agent number Initials
BWC-5026 (Rev. 12/03/2013)
OS-24
Quantity Form number Title
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
Quantity Form number Title
FFPH Fraud Flyer Pharmacy
FP 01 Fraud Poster
FS 01 Fraud Sticker
FS 01 Fraud Sticker
OS-24 Forms & Publications List
PERRP Safety and Health Protection on the Job Poster

Form Specifications

Fact Name Details
Purpose The OS-24 form is used to request various forms and publications related to workers' compensation services in Ohio.
Contact Information Individuals can reach the Ohio Bureau of Workers' Compensation by calling 1-800-OHIOBWC or by faxing at 614-621-5746 for assistance.
Physical Address Requirement Due to shipping regulations, the form requires a physical address for delivery, as post office boxes are not accepted.
Available Forms The OS-24 form provides a list of various forms available for different workers' compensation needs, including applications for benefits and reports.
Governing Law The OS-24 form is governed by the Ohio Revised Code, specifically Title 4123, which pertains to workers' compensation laws in Ohio.

Ohio Os 24: Usage Guidelines

Completing the Ohio OS-24 form is a straightforward process that requires attention to detail. This form is essential for requesting various forms and publications related to workers' compensation. Properly filling it out ensures that you receive the necessary materials in a timely manner.

  1. Provide your physical address: Enter your complete physical address, including street address, city, state, and ZIP code. Note that P.O. boxes are not accepted for delivery.
  2. Fill in your contact information: Input your date, customer ID number, contact name, telephone number, company name, and email address in the designated fields.
  3. Select the forms you need: In the section labeled "FORMS AVAILABLE," indicate the quantity of each form you wish to request by writing the number next to the corresponding form number.
  4. Review your information: Double-check all entries to ensure accuracy. Verify that your contact details and form selections are correct.
  5. Submit the form: Send the completed OS-24 form to the appropriate address or fax number provided on the form. Ensure you keep a copy for your records.

Your Questions, Answered

What is the Ohio OS 24 form?

The Ohio OS 24 form is a document used to request various forms and publications related to workers' compensation in Ohio. It serves as a means for individuals or organizations to obtain necessary paperwork from the Bureau of Workers' Compensation (BWC).

How can I submit the Ohio OS 24 form?

You can submit the Ohio OS 24 form by providing your physical address and contact information. Due to shipping regulations, deliveries cannot be made to post office boxes. The completed form can be sent via fax to 614-621-5746 or by contacting the BWC office directly.

What information do I need to provide on the OS 24 form?

When filling out the OS 24 form, you need to provide your customer ID number, contact name, telephone number, company name, email address, and physical address, including city, state, and ZIP code. This information is essential for processing your request accurately.

What types of forms are available through the OS 24 form?

The OS 24 form allows you to request a variety of forms related to workers' compensation, including but not limited to the AC-3 Temporary Authorization, C-5 Additional Information for Death Benefits, and C-84 Request for Temporary Total Compensation. A complete list of available forms is included with the OS 24 form.

Is there a limit to the number of forms I can request?

There is no specified limit to the number of forms you can request using the OS 24 form. However, it is advisable to only request forms that you genuinely need to ensure efficient processing.

Who should I contact if I have questions about the OS 24 form?

If you have questions regarding the OS 24 form or the forms available through it, you can call the BWC at 1-800-OHIOBWC. This hotline provides options for assistance and information related to workers' compensation.

Can I obtain Industrial Commission of Ohio forms through the OS 24 form?

No, the OS 24 form is specifically for requesting BWC forms and publications. If you need forms from the Industrial Commission of Ohio, you must call their forms and publications number at 614-644-8009.

What should I do if I need a form that is not listed on the OS 24 form?

If you require a form that is not listed on the OS 24 form, it is recommended to contact the BWC office directly for guidance. They may provide alternative solutions or direct you to the appropriate resources for obtaining the necessary forms.

Common mistakes

  1. Failing to provide a physical address instead of a post office box. The form explicitly states that deliveries cannot be made to P.O. boxes, which can lead to delays in receiving important documents.

  2. Omitting the Customer ID number. This number is crucial for processing the form accurately and efficiently.

  3. Incorrectly filling out the contact information. This includes providing an inaccurate telephone number or email address, which can hinder communication.

  4. Not specifying the quantity of forms requested. Each form needs to be clearly indicated to ensure the correct number is supplied.

  5. Leaving out the company name. This is essential for identifying the entity associated with the request and can cause confusion.

  6. Failing to include the date on the form. Without a date, it may be difficult to track the timeline of requests and submissions.

  7. Using incorrect or outdated form numbers. Each form has a specific number, and using an incorrect one can lead to processing errors.

  8. Not signing or dating the form where required. A missing signature can render the form invalid and delay processing.

Documents used along the form

The Ohio OS-24 form is a key document used in the workers' compensation process in Ohio. It is often accompanied by various other forms that serve specific purposes related to claims, medical documentation, and appeals. Below is a list of additional forms and documents commonly used alongside the OS-24 form.

  • AC-3 Temporary Authorization: This form allows for temporary authorization for medical treatment or services related to an injury.
  • C-5 Additional Information for Death Benefits: This document requests further details necessary for processing death benefit claims.
  • C-9 Physician’s Report/Treatment Plan: A report from a physician outlining the treatment plan for an injured worker.
  • C-11 Request to Appeal MCO Decision: This form is used to appeal a decision made by a Managed Care Organization regarding medical treatment.
  • C-84 Request for Temporary Total Compensation: This request is made for compensation during the period of temporary total disability.
  • FROI-1 First Report of Injury: This is the initial report filed to notify the Bureau of Workers' Compensation about an injury or occupational disease.
  • U-3 Application for Ohio Workers’ Compensation Coverage: This application is submitted to obtain coverage under Ohio’s workers' compensation system.
  • RH-1 Rehabilitation Agreement: This document outlines the terms of rehabilitation services for injured workers.

Each of these forms plays a vital role in ensuring that the workers' compensation process runs smoothly and that all necessary information is collected for effective claims management. Proper use of these documents can significantly impact the outcome of a claim or appeal.

Similar forms

The Ohio OS-24 form serves as a resource for various forms and publications related to workers' compensation. Several other documents share similarities with the OS-24 form in terms of purpose, structure, or the information they require. Here’s a list of eight documents that are comparable to the OS-24 form:

  • AC-3 Temporary Authorization: Like the OS-24, this form is used to grant temporary permission for specific actions related to workers' compensation claims.
  • C-5 Additional Information for Death Benefits: This document, similar to the OS-24, collects essential information necessary for processing claims related to death benefits.
  • C-9 Physician’s Report/Treatment Plan: This form is comparable to the OS-24 in that it requires medical documentation to support claims for industrial injuries or occupational diseases.
  • C-11 Request to Appeal MCO Medical Treatment/Service Decision: Like the OS-24, this form is used to initiate an appeal process, ensuring that all necessary information is submitted for review.
  • C-18 Wage Agreement: This document outlines wage agreements and is similar to the OS-24 in that it requires specific details regarding compensation.
  • C-84 Request for Temporary Total Compensation: This form, like the OS-24, is essential for requesting benefits and requires detailed information about the claimant's situation.
  • FROI-1 First Report of Injury: This document is similar to the OS-24 as it serves as an initial report that provides critical information about workplace injuries.
  • U-3 Application for Ohio Workers’ Compensation Coverage: Like the OS-24, this form is vital for establishing coverage under Ohio's workers' compensation system.

Dos and Don'ts

When filling out the Ohio OS-24 form, it’s important to follow some key guidelines. Here are four things you should and shouldn’t do:

  • Do provide your physical address. Avoid using a P.O. box.
  • Do double-check all your information for accuracy before submitting the form.
  • Don't leave any required fields blank. Incomplete forms may delay processing.
  • Don't forget to sign and date the form where indicated.

Misconceptions

Misconceptions about the Ohio OS-24 form can lead to confusion regarding its purpose and usage. Here are seven common misconceptions:

  • The OS-24 form is only for injured workers. This form is used for a variety of purposes, including requests for publications and forms related to workers' compensation, not just for injured workers.
  • All forms related to workers' compensation are included in the OS-24. The OS-24 only lists specific forms available through the Bureau of Workers' Compensation (BWC). Other forms may be available through different agencies.
  • You can submit the OS-24 form to a P.O. Box. The BWC requires a physical address for delivery, as they cannot ship to P.O. Boxes.
  • The OS-24 form is the only way to request forms and publications. While it is a primary method, individuals can also contact the BWC directly via phone for assistance.
  • There are no deadlines for submitting the OS-24 form. Timeliness can be important, especially if the request is related to ongoing claims or benefits.
  • All publications listed on the OS-24 form are free. Some publications may have associated costs, so it's advisable to check before ordering.
  • The OS-24 form is only for employers. It is available for use by both employers and employees seeking information or forms related to workers' compensation.

Understanding these misconceptions can help individuals navigate the workers' compensation system in Ohio more effectively.

Key takeaways

Filling out the Ohio OS-24 form can be straightforward if you keep a few key points in mind. Here are some important takeaways to help you navigate the process:

  • Provide Accurate Information: Ensure that all your details, such as your physical address, customer ID number, and contact information, are correct. This helps avoid delays in processing.
  • No P.O. Boxes: The form requires a physical address for delivery purposes. Keep in mind that post office boxes are not accepted.
  • Understand the Forms Available: The OS-24 form lists various other forms related to workers' compensation. Familiarize yourself with these to determine which may be relevant to your situation.
  • Quantity Matters: When requesting forms, indicate the quantity you need. This ensures you receive enough copies for your records and any necessary submissions.
  • Contact Information: Provide your contact name and telephone number. This allows the office to reach you if there are questions or issues with your submission.
  • Delivery Options: Be aware of the delivery methods available. The Ohio Bureau of Workers' Compensation may use UPS, so plan accordingly.
  • Stay Informed: If you need forms not listed on the OS-24, know that you can obtain them by contacting the Industrial Commission of Ohio directly.

By keeping these points in mind, you can fill out the Ohio OS-24 form effectively and ensure that your workers' compensation needs are addressed promptly.