Are you an Ohio business owner looking to file your personal or corporate report with the Ohio Bureau of Workers’ Compensation (BWC)? The BWC requires all entities operating in the state to submit their medical, disability and other reporting documents as a part of their labor and safety compliance. If that sounds like a daunting task, don’t worry—we have you covered. In this blog post, we will cover everything you need to know about filing Form Bwc 1389 with the State of Ohio annually. Read on for important information about what Form Bwc 1389 entails, how it applies to compensation for injured workers in your organization, and steps to complete annual filing.
| Question | Answer |
|---|---|
| Form Name | Ohio Form Bwc 1389 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | c 257 ohio bureau of workers comp authorization to release information pdf |
AUTHORIZATION TO RELEASE
INFORMATION
USE THIS FORM IF you want BWC to share the information we have about you with another person such as:
•A family member, friend or other relative;
•Someone who helps take care of you;
•Someone who helps you ill out BWC forms.
This authorization is only valid for one year from date of signature.
Name |
Date of birth |
Claim number |
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Address
City
State
I authorize BWC to release information to the person named |
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I authorize BWC to release information to the person named |
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below. |
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below. |
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Name/relationship |
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Name/relationship |
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And/or |
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Address |
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Address |
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City, State, ZIP code |
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City, State, ZIP code |
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Phone number |
Fax number |
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Phone number |
Fax number |
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Specific information authorized
Claims status
Other
Medical documentation
Wages/payments
All
Injured worker (or guardian or personal representative) signature
Date
If signed by the injured worker's guardian or personal representative, provide here a description of the guardian
or personal representative’s authority to sign on behalf of the injured worker.
.