Free Ohio Os 24 Template Launch Editor

Free Ohio Os 24 Template

The Ohio OS 24 form plays a crucial role for businesses and individuals needing to access workers' compensation forms and publications through the Office Services of the Ohio Bureau of Workers' Compensation (BWC). Located at 3655 Brookham Drive in Grove City, Ohio, this service offers a wide array of essential documents necessary for managing workers' compensation claims and related procedures. Users are encouraged to provide a physical address for delivery, as postal box deliveries are restricted due to United Parcel Services' shipping regulations.

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The Ohio OS 24 form serves as a critical tool for managing and accessing various forms and publications related to workers' compensation and workplace safety in Ohio. Located at the Office Services Forms & Publications in Grove City, this resource is essential for employers, medical providers, and employees navigating the intricacies of workers' compensation claims and compliance. With a comprehensive list that includes but is not limited to forms for temporary authorization, death benefits, treatment plans, wage agreements, and applications for compensation, the Ohio OS 24 enables streamlined communication and efficient processing of essential documents. Additionally, it caters to a broader spectrum of needs by offering publications on medical guides, fraud awareness, and safety regulations. This availability bolsters understanding and adherence to Ohio’s workers' compensation system, ensuring stakeholders have the necessary tools at their disposal to advocate for their rights, fulfill their responsibilities, and promote a safe working environment. Given the form's directive to provide a physical address for delivery due to United Parcel Services' shipping regulations, the system underscores the importance of tangible, accessible resources in the digital age. Aimed at simplifying administrative procedures, the Ohio OS 24 form is indispensable for promptly addressing the diverse needs of Ohio’s workforce and employers.

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OFCE SERVICES FORMS & PUBLICATIONS 3655 Brookham Drive Grove City, Ohio 43123

Call: 1-800-OHIOBWC, and listen to the options Fax: 614-621-5746

Please provide your physical address.

Due to United Parcel Services’ shipping regulations, we cannot to make deliveries to post office boxes.

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.

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

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

Application for Optional Supplemental Coverage

 

U-118

Notification of Business

 

 

Acquisition/Merger or Purchase/Sale

 

 

 

BWC-5026 (REV. 12/03/2013)

OS-24

PUBLICATIONS AVAILABLE

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

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.

BWC-5026 (REV. 12/03/2013)

OS-24

Document Specifications

Fact Number Detail
1 The Ohio OS 24 form is a comprehensive catalog of forms and publications available from the Ohio Bureau of Worker’s Compensation (BWC).
2 It includes forms for a wide range of purposes, including injury reporting, medical treatment, and compensation claims.
3 The form is used by employers, injured workers, and healthcare providers involved in the workers' compensation process.
4 Forms related to fraud, safety and health protection, and vocational rehabilitation are also listed in the OS 24 document.
5 Located at 3655 Brookham Drive Grove City, Ohio, the BWC specifies shipment can only be made to physical addresses, not PO boxes, due to United Parcel Services’ regulations.
6 Requests for these forms and publications can be submitted via phone, fax or presumably through their online platform.
7 Governing law(s) for the documents and processes outlined within the OS 24 form would primarily fall under Ohio workers' compensation law.
8 Industrial Commission of Ohio (IC) forms are not provided through the BWC office services but can be obtained by calling the IC forms and publications number directly.

How to Use Ohio Os 24

Filling out the Ohio OS-24 form is a straightforward process that involves providing detailed information about the forms and publications you need from the Office of Worker’s Compensation. This guide will show you how to navigate through each section, ensuring your request is processed efficiently.

  1. Locate the section labeled "Please provide your physical address." Enter your complete physical address here, including the city, state, and ZIP code, to comply with delivery regulations.
  2. In the space provided, enter the current date to ensure the request is timely.
  3. Input your Customer ID Number, which is unique to you or your organization, to facilitate tracking and processing.
  4. Fill in your contact name, ensuring you use the name of the person who should be contacted regarding this request.
  5. Provide a telephone number where this contact person can be easily reached during business hours.
  6. Write down the company name to clarify the entity making the request.
  7. Enter a valid email address to receive confirmations or communications related to your request.
  8. Under the "FORMS AVAILABLE" and "PUBLICATIONS AVAILABLE" sections, specify the quantity of each form or publication you need by writing the number in the “Quantity” column next to the Form No. and Title.
  9. For the "Prepared by" section at the bottom, the agent handling this request must fill in their agent number and initials, confirming who prepared the form.
  10. Lastly, double-check all the information for accuracy before faxing it to 614-621-5746. Ensure the fax number is dialed correctly to prevent misdelivery.

After submitting the form, your request for forms and publications will be processed. Keep in mind, if additional information or clarification is necessary, you may be contacted via the telephone number or email provided. Please allow some time for delivery, keeping in mind that delivery times can vary. Should you have questions about your request or need further assistance, don’t hesitate to reach out to the Office of Worker’s Compensation at 1-800-OHIOBWC.

Crucial Questions on This Form

What is the Ohio OS 24 form?

The Ohio OS 24 form is a comprehensive list and request form for various workers' compensation documents and publications available through the Ohio Bureau of Workers' Compensation (BWC). It includes options for ordering forms related to injury claims, medical treatment, compensation, employer responsibilities, and workers' rights among others.

How can I order forms or publications using the Ohio OS 24 form?

To order forms or publications using the Ohio OS 24 form, you need to provide your contact information, including your physical address, and specify the quantity and the form numbers of the documents you wish to order. You cannot request deliveries to post office boxes due to United Parcel Services’ shipping regulations. You can then fax your completed form to 614-621-5746 or call 1-800-OHIOBWC for further instructions.

Why can't I have documents delivered to a PO Box?

Due to shipping regulations set by United Parcel Services (UPS), deliveries cannot be made to post office boxes. This ensures that the materials are securely delivered to physical addresses where recipients can directly receive and sign for them if necessary.

What are some examples of forms available through the OS 24 form?

Examples include AC-3 Temporary Authorization, C-9 Physician’s Report/Treatment Plan, C-84 Request for Temporary Total Compensation, MEDCO-13 Application for Provider Enrollment and Certification, and many others designed to aid in the workers' compensation claims process and ensure proper health care and compensation for workers.

Are there any resources available for addressing fraud?

Yes, the OS 24 form lists various fraud-related resources such as the Fraud Brochure for different sectors (law, managed care organizations, self-insured entities), Fraud Flyers (Financial, Pharmacy), and Fraud Posters, aimed at educating and preventing workers' compensation fraud.

Can I find rehabilitation and training agreements on the OS 24 form?

Yes, there are forms such as RH-6 On-The-Job Training Agreement, RH-7 Loan/Lease Agreement for Tools and Equipment, and RH-24 Gradual Return to Work Contract among others focused on rehabilitation and vocational training for injured workers.

How do I obtain forms not listed on the OS 24 form?

For forms not listed on the OS 24, individuals should contact the Industrial Commission of Ohio (IC) by calling their forms and publications number at 614-644-8009 to access additional resources not available through the BWC's office services.

Who prepares the OS 24 form?

The OS 24 form is prepared by an agent of the Ohio Bureau of Workers' Compensation, as indicated by the section for "Prepared by Agent number" and "Initials" at the bottom of the form. This ensures that the form and its contents are officially sanctioned and up to date.

Is there a charge for ordering through the OS 24 form?

The form itself does not specify charges for the ordering of documents. Typically, materials provided by state agencies like the Ohio BWC for workers' compensation purposes are available free of charge or at a nominal printing cost. However, for large bulk orders, it's advisable to contact the BWC directly to inquire about any potential costs.

How often is the OS 24 form updated?

The revision date at the bottom of the OS 24 form indicates its latest update. While the form specifies a revision date of December 3, 2013, it is essential to check with the Ohio BWC directly or visit their website to ensure you have the most current version and information regarding available forms and publications.

Common mistakes

When filling out the Ohio OS 24 form, attention to detail is crucial for a smooth process. Unfortunately, errors can occur, which may lead to delays or complications. Below are nine common mistakes individuals make when completing this form:

  1. Providing an incorrect or outdated physical address: Since deliveries cannot be made to post office boxes due to United Parcel Services’ shipping regulations, always ensure the physical address is current and accurate.
  2. Forgetting to include the date: This might seem minor, but dates are essential for record-keeping and processing.
  3. Omitting the customer ID number: This is a unique identifier that helps in tracking your form and associating it with your account.
  4. Not specifying a contact name: It's necessary for communication, especially if there are questions or additional information is needed regarding your submission.
  5. Leaving the telephone number field blank: A direct line of communication is vital for any clarifications or follow-up.
  6. Entering an incorrect or incomplete company name: This ensures that documents and communications are properly directed.
  7. Miswriting the email address: Email is often used for sending confirmations, updates, or requests for additional information.
  8. Failure to accurately fill out the address, city, state, and ZIP code fields: Precision here is key for ensuring that any mailed documents reach the right destination.
  9. Not clearly indicating the quantity and form number of each requested form: This information is critical for fulfilling your order correctly.

While filling out forms can be tedious, paying close attention to these details will ensure that your experience with the Ohio OS 24 form is as smooth and efficient as possible. Taking the time to review and double-check your information before submission can save you a significant amount of time and effort in the long run.

Documents used along the form

When managing workers' compensation claims in Ohio, the OS-24 form provides a comprehensive list of forms and publications that businesses, healthcare providers, and injured workers might need. However, alongside the OS-24 form, there are other essential documents and forms frequently required to successfully navigate the claims process. These documents help ensure that all aspects of a claim are properly documented, appealed, or processed for benefits.

  • FROI-1 (First Report of Injury, Occupational Disease or Death): This form initiates a workers' compensation claim. It is used by employers to report an employee's injury, occupational disease, or death that occurred as a result of their job.
  • MEDCO-14 (Report of Work Ability): This form is filled out by healthcare providers to document an injured worker's ability to return to work, including any restrictions or modifications needed.
  • C-84 (Request for Temporary Total Compensation): Injured workers use this form to apply for temporary total disability benefits when they are unable to return to their former position of employment temporarily due to a work-related injury or illness.
  • RH-1 (Rehabilitation Agreement): This document outlines the terms and goals of vocational rehabilitation for an injured worker. It's a key part of creating a structured plan to return the injured worker to employment.
  • C-240 (Notice of Exception to Employer’s Signature Requirement): This notice is used when there is an exception to the standard requirement for an employer’s signature in certain processes, facilitating smoother processing of some compensation claims.

These documents play vital roles in the life cycle of a workers' compensation claim. From reporting the injury and assessing work ability to applying for benefits and agreeing on a rehabilitation plan, each form addresses a different need that arises during the claim process. Understanding and utilizing these forms correctly can streamline the process, ensuring that injured workers receive the support they need for recovery and return to work.

Similar forms

The Ohio OS 24 form, serving as a comprehensive directory for workers' compensation documents and resources, shows similarities to the First Report of Injury, Occupational Disease or Death (FROI-1) form. Both are integral to the process of managing workers' compensation claims in Ohio. The FROI-1 initiates the claims process by documenting the initial report of an injury, occupational disease, or death resulting from workplace activities. Like the OS 24, it facilitates the necessary administrative steps to ensure that workers receive appropriate compensation and benefits following a workplace incident. Each form plays a crucial role in the overarching structure of workers' compensation procedures, ensuring both the workers' and the employers' obligations and rights are clearly communicated and upheld.

The MEDCO-13, or the Application for Provider Enrollment and Certification, represents another document with functions akin to those found in the OS 24 form. While the OS 24 form lists available forms and publications related to workers' compensation, the MEDCO-13 specifically caters to healthcare providers seeking to participate in the Ohio Bureau of Workers' Compensation (BWC) network. This form is essential for medical practitioners aiming to deliver care to injured workers under the state's compensation system. Both documents underscore the breadth of administrative tasks associated with workers' compensation, making it easier for relevant stakeholders, whether healthcare providers or injured workers, to navigate through the system seamlessly.

Similarly, the C-84 Request for Temporary Total Compensation form mirrors the OS 24 form in its purpose to streamline workers' compensation processes. The C-84 form is used specifically by workers who seek to receive temporary total disability benefits due to workplace injuries that prevent them from returning to work momentarily. It's an essential document for initiating the benefit claim process within Ohio's workers' compensation framework. By including such forms in the OS 24 list, stakeholders are provided with a roadmap to accessing critical resources for managing the aftermath of workplace injuries, emphasizing the system's commitment to worker recovery and support.

The C-240 Notice of Exception to Employer’s Signature Requirement and its amendment, the C-240A, highlight procedural nuances in workers' compensation claims, similar to the varied documentation outlined in the OS 24 form. These forms specifically address exceptions to the standard requirement of an employer's signature for certain claim processes, offering flexibility in how claims can be managed and expedited. The inclusion of such forms within the OS 24 catalog illustrates the complexities and adaptivities inherent in handling workers' compensation cases, ensuring all parties are aware of the avenues available for facilitating claim resolution.

Lastly, the RH-24 Gradual Return to Work Contract mirrors the facilitative nature of the OS 24 form by providing a structured plan to reintegrate injured workers back into the workforce. This document represents an agreement between the employer and employee on a modified or reduced work schedule following an injury, balancing the worker's health recovery with their return to productivity. Both the RH-24 and the OS 24 form play pivotal roles in the holistic approach to workers' compensation, acknowledging the importance of recovery, rehabilitation, and reemployment in the journey back to regular employment.

Dos and Don'ts

When filling out the Ohio OS-24 form, there are several dos and don'ts to keep in mind to ensure the process is completed accurately and efficiently. Here are key pointers to consider:

Do:
  • Provide your physical address clearly: Due to shipping regulations by United Parcel Services, it's essential to give a physical location as PO Boxes are not acceptable for deliveries.
  • Double-check the form numbers and titles you are requesting: Make sure the quantities and form numbers match your needs to avoid any confusion or delays.
  • Include all relevant details such as the Date, Customer ID number, Contact name, Telephone number, Company name, Email address, and the full address including the City, State, and ZIP code.
  • Verify your contact information: Ensure your telephone number and email address are current to facilitate seamless communication.
  • Contact the Industrial Commission of Ohio (IC) for forms not listed on the OS-24 form by calling their forms and publications number.
Don't:
  • Leave any required fields blank: Incomplete information can lead to processing delays or even the form being returned to you.
  • Provide a post office box for delivery: As stated earlier, shipments cannot be made to PO boxes, so always provide a street address.
  • Forget to state the quantity of each form needed: Without clear quantities, there could be confusion, resulting in either too few or too many copies being sent.
  • Assume all forms are available through BWC office services: The OS-24 form lists specific forms available. If a form is not listed, it's not available through this channel.
  • Overlook the agent number and initials at the bottom of the form, if applicable: This could be essential for internal tracking and processing of your request.

Misconceptions

When dealing with the Ohio OS 24 form, it's essential to approach the document and the ensuing procedures with a clear understanding. However, several misconceptions can lead to confusion and inefficiency. Here are eight common misunderstandings about the Ohio OS 24 form and their clarifications to help guide individuals and businesses through the process:

  • OS 24 is the only form needed for worker's compensation cases: While the OS 24 form lists various forms related to worker's compensation, each serves a specific purpose, and depending on the situation, multiple forms may be necessary.

  • Forms can only be submitted physically: Despite the emphasis on providing a physical address for shipping regulations, many of these forms and applications can also be submitted electronically, increasing accessibility and efficiency.

  • All forms are available through the Office Services Forms & Publications: The list explicitly states that some forms not listed may need to be obtained through the Industrial Commission of Ohio (IC), indicating not all necessary forms are available through the BWC office services.

  • The quantity indicates the forms' relevance or necessity: The option to request a quantity of forms does not relate to their importance but rather serves to accommodate the needs of requesting parties for distribution or repeated use.

  • Email is not an official channel for submission or communication: Email addresses are requested in the form, acknowledging email as a valid and recognized means for submitting forms or communications.

  • There's no way to request a form that's not listed: The document advises contacting another number for forms not available through BWC Office Services, showing that unlisted forms are accessible through alternate channels.

  • All worker's compensation forms are directly related to injury claims: While many forms pertain to injury or occupational disease, others, like those for fraud or safety and health protection, address different aspects of workplace well-being and compliance.

  • Updating personal information is complicated: The inclusion of forms such as the C-77 for changing the address simplifies the process of updating personal information, making it less burdensome for the injured worker.

Clearing up these misconceptions fosters a better understanding of the Ohio OS 24 form and its associated procedures. This, in turn, can lead to more effective handling of workers' compensation cases and related matters.

Key takeaways

When dealing with the Ohio OS 24 form, it is essential to focus on key aspects for a smooth and accurate process. Here are six takeaways:

  • Ensure all required sections are thoroughly completed, including your physical address. Due to shipping regulations, deliveries cannot be made to PO boxes.
  • For any form requests or publications listed on the OS 24, including forms like the AC-3 (Temporary Authorization) or C-9 (Physician’s Report/Treatment Plan), specify the necessary quantity clearly.
  • When submitting the form, always provide up-to-date contact information, ensuring the telephone number and email address are current. This facilitates prompt communication.
  • Take note of the unique forms available for various processes, such as the C-84 (Request for Temporary Total Compensation) and C-92 (Application for Determination of the Percentage of Permanent Partial Disability), which cover different injury or compensation scenarios.
  • Remember that forms not listed on the OS 24, particularly those related to the Industrial Commission of Ohio (IC), can be acquired by contacting the IC forms and publications number directly.
  • Always check the version date of the OS 24 form (in this case, BWC-5026 REV. 12/03/2013) to ensure the use of the most current form for accurate compliance and submission.

This checklist ensures accurate and compliant completion and submission of the Ohio OS 24 form for individuals and employers seeking assistance from the Bureau of Workers' Compensation (BWC).

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