| Title |
Last Updated |
| Amended Settlement Agreement And Release |
March 4, 2015 |
| State Fund Employers Agreement To Accept Claim Assignment |
February 25, 2015 |
| Self-Insured Employers Certification Of Assignment After Initial Allowance |
February 25, 2015 |
| Self-Assessment For 10-Step Business Plan For Safety |
February 25, 2015 |
| Request To Correct Employer And Or Policy Number Assignment |
February 25, 2015 |
| Lump Sum Settlement (LSS) |
February 25, 2015 |
| Filing Of An Allegation Against A Self Insured Employer |
February 25, 2015 |
| Application For Ohio Workers Compensation Coverage |
February 25, 2015 |
| Application For Drug Safety Program |
February 25, 2015 |
| Rehabilitation Election |
January 20, 2014 |
| Plan Of Action |
January 20, 2014 |
| Lump Sum Settlement (LSS) Direct Reimbursement Payment and Rating Program For Public Employer State Agencies |
January 17, 2014 |
| Labor Lease Transaction Payroll |
January 17, 2014 |
| Handicap Reimbursement Election |
January 17, 2014 |
| Objection To Tentative Order |
August 19, 2013 |
| Self-Insurers Agreement As To Compensation On Account Of Death |
August 19, 2013 |
| Unconditional And Continuing Guarantee |
August 19, 2013 |
| Amended Payroll Report |
August 16, 2013 |
| Acknowledgment Of The Self Insured Joint Settlement Agreement And Release |
August 7, 2013 |
| Wage Statement |
July 15, 2013 |
| Application For Renewal Of Authorization To Operate As A Self-Insured Risk |
July 15, 2013 |
| Waiver Of Appeal Period |
July 5, 2012 |
| Application For Drug Free Workplace Program And Drug Free EZ |
July 5, 2012 |
| Labor Lease Transaction Claims |
August 23, 2011 |
| Report Of Paid Compensation And Statistical Information |
April 7, 2011 |
| Safety Review |
April 7, 2011 |
| Contract For Coverage Of State Agency Of Political Subdivision |
April 7, 2011 |
| Application For Retrospective Rating Plan For Public Employers |
April 7, 2011 |
| Accident Report |
April 7, 2011 |
| Notification Of Business Aquisition Or Merger Or Purchase Or Sale |
January 14, 2011 |
| Request For Medical Information |
January 13, 2011 |
| Private Employer Agreement For 100 Percent EM Cap |
January 13, 2011 |
| Agreement For Construction |
January 13, 2011 |
| Waiver Of Examination Statewide Disability Evaluation System |
November 8, 2010 |
| Initial Application By Employer For Authority To Pay Compensation Directly |
November 8, 2010 |
| Application For Handicap Reimbursement |
November 8, 2010 |
| Agreement Between Employer And The Ohio Bureau Of Workers Compensation Regarding Amount Of Self Insured Buyout |
June 1, 2009 |
| Waiver Of Appeal Period |
March 27, 2009 |
| Progress Report Drug Free Workplace Drug Free EZ Program |
March 27, 2009 |
| Employer Incentive Contract |
March 3, 2009 |
| Trainers Report |
December 4, 2008 |
| Request For Temporary Total Compensation |
September 19, 2008 |
| Application For The Premium Discount Program |
June 2, 2008 |
| Plan Of Action |
January 3, 2008 |
| Employer Authorized Representative |
December 4, 2006 |
| Employer Adjudication Protest |
November 29, 2006 |
| Self-Insurers Agreement As To Compensation On Account Of Death |
October 24, 2005 |
| Transitional Workgrant EZ Reimbursement Request |
October 24, 2005 |
| Transitional WorkGrant EZ Reimbursement Request Additional Services |
October 24, 2005 |
| Transitional Workgrant EZ Program Agreement |
October 24, 2005 |
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