Filling out Ohio's Bureau of Workers’ Compensation (BWC) form 3907 can be a confusing and intimidating task. Understanding the purpose of this form, when it is necessary to submit, what qualifies as an acceptable signature and potential consequences for noncompliance are some important steps to consider before providing your information on the document. This blog post will provide an in-depth look at understanding Ohio BWC Form 3907, offering guidance on completing it correctly so you remain compliant with local laws and regulations.
| Question | Answer |
|---|---|
| Form Name | Ohio Form Bwc 3907 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | Ohio, bwc 337 form, bwc 337, Revised |
Waiver of Examination
Statewide Disability Evaluation System
•The employer should sign and date the form.
Injured worker name
Claim number
The employer or BWC has waived the medical examination, which Section 4123.53 (B) of the Ohio Revised
Code requires after 90 consecutive days of temporary total disability compensation. The employer or BWC
has waived the exam Temporarily or
Permanently |
for the following reason: |
Injured worker remains hospitalized; Injured worker is scheduled for surgery; Injured worker is scheduled to return to work on;
Other
.
Waiver authorized by:
Employer name
Date
Employer representative
Title
Requested
The BWC nurse has recommended to waive the examination.
Signature of
Signature
Date
BWC use only
BWC has approved the request for waiver.
BWC has denied the request for waiver for the following reasons:
Signature
Date