Bwc c 86 form 2026

1. Click ‘Get Form’ to open the bwc c 86 form in our editor.
2. In Section I, enter your complete name, street address, city, state, ZIP code, and claim number. Ensure all information is accurate for proper processing.
3. Move to Section II and specify the additional condition you want the Ohio Bureau of Workers' Compensation (BWC) to consider. If applicable, include a statement for psychiatric conditions acknowledging their relation to your injury.
4. For wage adjustments, clearly state your current wage and the desired adjustment amount. In case of self-insured claim disputes, detail the specific issue you are disputing.
5. In Section III, indicate any supporting evidence included with your motion. Attach relevant medical documentation or earning statements that substantiate your request.
6. Finally, sign and date the Certificate of Service section to confirm that copies have been sent to all parties involved in your claim.

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