Form BWC-3907 at a glance
What it is: Form BWC-3907 (MEDCO-6) is the form on which the employer of the injured worker authorizes waiver of the 90 Day Exam.
Who signs: The employer or employer representative signs.
A filled-in Form BWC-3907 example: an employer waives the 90 Day Exam
How to fill out Form BWC-3907, box by box
Claim number(s) and injured worker information
Enter the Claim number(s).
Under Injured worker information, enter the Name.
Waiver information
The “90 Day Exam” is a medical examination of the injured worker that is generally done after 90 consecutive days of temporary total disability compensation has been paid.
Under Waiver information: as the employer of the injured worker, you authorize waiver of the medical examination, the “90 Day Exam”, for the following reason(s).
Mark each that applies: injured worker remains hospitalized; has just been released from the hospital and is home recovering; or is scheduled for or is recovering from surgery.
Mark if the injured worker has been referred for vocational rehabilitation or is actively participating in a vocational rehabilitation plan, appears to be on track to return to work and an exam does not appear to be necessary at this time, or is scheduled to return to work on (write it on the line).
Mark Other (please explain) and write it on the lines.
My waiver of this exam is (please check one)
Check one for My waiver of this exam: Permanent, Temporary or Requested follow-up examination date, and enter the date for the follow-up.
Employer/employer representative signature
Enter Signature, Print name, Title and Date.
Check the box if you are a non-attorney representative for the employer who is signing at the direction of the employer.
Sources
[1] Form BWC-3907 (Rev. Feb. 19, 2026), MEDCO-6, Ohio Bureau of Workers' Compensation (the Official source link on this page).