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Bwc 1101 rev 6 12 2014

Bwc 1101 rev 6 12 2014-2026

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The document is a form for reporting an injury, occupational disease, or death to the Ohio Bureau of Workers' Compensation (BWC). It outlines the steps for injured workers to complete and submit the First Report of an Injury (FROI), including sections for personal information, details about the injury, and treatment information. The form must be submitted to the employer or their managed care organization (MCO), with instructions provided for self-insuring employers and contact information for various BWC customer service offices.

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Click ‘Get Form’ to open the bwc 1101 rev 6 12 2014 in the editor.
Begin by filling out the injured worker's personal information, including their last name, first name, middle initial, and social security number. Ensure accuracy as this information is crucial for processing.
In section one, provide details about the injury or occupational disease. Include the date of injury, time of injury, and a description of the accident. This section is vital for establishing the claim.
Complete section two with employer information. Enter the employer's name, department, and address. If applicable, indicate if the employer is self-insuring.
In section three, ensure that all medical treatment information is filled out accurately. This includes healthcare provider details and any diagnoses related to the injury.
Review all sections for completeness and accuracy before submitting. Utilize our platform’s features to save your progress and make edits as needed.

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What is my Ohio BWC provider number?

Providers may also email or call MCOs or our provider contact center at feedback.medical@bwc.state.oh.us or 1-800-477-2292 to obtain their provider number.

How does workers comp work in Ohio?

BWC pays medical benefits and lost wages to employees who are injured or contract an occupational disease on the job. We also pay death benefits to survivors when a death results from a work-related injury or disease. Ohio law requires employers to obtain workers' compensation insurance for all employees.

What is first report of injury form Ohio?

OhioBWC - Common - Form: (FROI) - Introduction. Injured workers, employers or medical providers use this form to initiate a workers' compensation claim. Whoever completes the form should provide as much detailed information as possible.

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