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Claimant Authorized Representative (R-2) - Ohio BWC

Claimant Authorized Representative (R-2) - Ohio BWC 2025

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The document is a form for designating an authorized representative for a claimant in a workers' compensation claim. It requires the claimant's and representative's information, including names, contact details, and BWC ID number. The form outlines the authorization process, stating that only one legal representative can be designated at a time and that previous authorizations must be canceled separately. The completed form can be submitted via fax or in person.

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Click ‘Get Form’ to open the Claimant Authorized Representative (R-2) in the editor.
Begin by filling out the 'Claimant Information' section. Enter your name, date of injury, claim number, address, city, state, email address (if available), phone number, and ZIP code.
Next, move to the 'Representative Information' section. Here, provide the name of your representative or firm, their BWC ID number, phone number, street address, city, state, ZIP code, and email address (if available). Remember that you can only designate one legal representative.
In the 'Authorization' section, read through the statements carefully. Confirm your understanding by signing and printing your name along with the date of authorization. Ensure you select whether your representative is an attorney, law firm, or union representative.
Once completed, save your form and choose to fax it to 1-614-621-3437 or submit it at the Representative Desk in the William Green building.

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What makes someone an authorized representative?

An authorized representative (AR) is a person or organization who can act on behalf of an individual to help apply for and/or keep Medicaid, SNAP and/or TANF/OWF coverage. Naming an AR is optional and can be time limited.

What are the common Ohio BWC claim issues?

Here are some common grounds for denial: Insufficient work connection: The injury wasnt clearly related to job duties. Incomplete medical documentation: Lack of proper medical evidence supporting the claim. Missed deadlines: Failing to report the injury or file the claim within the required timeframes.

What is an authorized representative in Ohio?

An authorized representative is the person you choose to help with or handle affairs related to your health care services. This can be a Power of Attorney, a family member, friend, caregiver or an advocate. Your authorized representative would help you with an exception, appeal, or grievance.