Form c19 bwc bureau compensation form 2025

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The document is a Service Invoice form used for billing related to injured workers. It includes sections for personal information, service details, and provider certification. The form must be completed accurately and submitted to the appropriate party, following guidelines from the BWC's Billing and Reimbursement Manual.

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Click ‘Get Form’ to open the c19 bwc bureau compensation form in the editor.
Begin by filling in the 'Bill type' section. Check the appropriate box that corresponds to your billing type.
Enter the injured worker's name, including last, first, and middle initial in the designated fields.
Provide the injured worker's address, ensuring you include street or P.O. Box, city, state, and ZIP code.
Fill in the date of injury and claim number accurately to avoid processing delays.
Complete sections for referring physician details, including their name and provider number.
Input service details such as procedure codes and total charges in the respective fields.
Finally, review all entries for accuracy before signing and certifying that the information is true and correct.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Am I required to have workers comp insurance in Ohio?

Yes. Ohio companies with any employeeseven if they just have one person working for themmust purchase workers compensation insurance to protect their employees when they suffer work-related injuries.

How to cancel Ohio BWC?

Canceling coverage Cancel your policy online. Submitting a Request to Cancel Workers Compensation Coverage (U-114) (PDF) Phone by an authorized representative or employer contact on the policy. Sending a letter to BWC that includes the date you last had an employee and the date you want to cancel the coverage.

Is Ohio BWC mandatory?

As an Ohio employer with one or more employees, Ohio law requires you to have workers compensation coverage.

How can I check my Ohio BWC claim status?

You can view bill information related to a claim online with your OHID account.

What is the BWC in Ohio?

Established in 1912, the Ohio Bureau of Workers Compensation is the exclusive provider of workers compensation insurance in Ohio, serving 258,000 public and private employers. With over 1,600 employees and assets of approximately $23 billion, BWC is one of the largest state-run insurance systems in the United States.

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How do I report a claim to BWC in Ohio?

Phone: Call BWC at 800-644-6292 from 7:30 a.m. to 5:30 p.m. (EST) or a local BWC customer service office. The customer service representative will ask questions needed to complete the form and submit it.

What is the penalty for not having workers compensation in Ohio?

Any employer that fails to pay its premium or fails to apply for workers compensation coverage is considered a non-complying employer. Non-complying employers may have a lien placed on both business property and tangible personal property until all monies due have been paid.

How do I pay my Ohio BWC premium?

Once you have an OHID account, log in to our website and click the Make a payment button. You can pay online with: A credit card (MasterCard, VISA or American Express) A checking or savings account withdrawal.

Form c19 bwc bureau compensation form 2025

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See more form c19 bwc bureau compensation form versions

Complete this form in 5 minutes or less

Got questions?

Am I required to have workers comp insurance in Ohio?

How to cancel Ohio BWC?

Is Ohio BWC mandatory?

How can I check my Ohio BWC claim status?

What is the BWC in Ohio?

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How do I report a claim to BWC in Ohio?

What is the penalty for not having workers compensation in Ohio?

How do I pay my Ohio BWC premium?

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