We help Ohio business owners navigate multi-state coverage.

Ohio business owners and employers are welcome to download and use our forms and documents from our forms library. We make every effort to keep our forms and documents updated with the most recent versions for your convenience.

Ohio operates as a monopolistic state fund. It is part of a state controlled workers compensation plan. The state does not allow private insurance carriers to provide policy coverage in this state and therefore we do not offer any forms at the present time.

Our agency is a national insurance agency specializing in multi-state workers' compensation insurance coverage. We help employers find out-of-state workers comp policies when they hire employees in other states or travel outside their state for work.

Ohio Workers Compensation Insurance Forms

Ohio Acord 130 Workers Compensation Application

The standard Acord 130 application form for workers comp coverage in Ohio.

Ohio First Report of Injury Form

First Report of Injury Form.  Employers should complete this form and send to their insurance company each time an injury occurs.

Ohio Application for Exclusion of Officers and Stockholders

Owners and Officers of corporations should complete this form to exclude themselves from a work comp policy.

Ohio Application for Exemption for Workers' Compensation Insurance

Complete this form if you are a sole-proprietor, partnership with no employees or an officer of a corporation and would like to be exempt from coverage.

Ohio Application for Deductible Program

Complete this form is you wish to apply for the Ohio Deductible Program.

Apprenticeship Elective Coverage Contract

Contract for apprentices to elect coverage.

Apprenticeship Elective Coverage Contract

Contract for apprentices to elect coverage.

Application for Permanent Authorization

Complete this for to give authorization to an Employer risk claim representative, Risk management representative, or Claim management representative.

Claim Reimbursement Withdrawal Form

Complete this form to elect to withdraw from the claims reimbursement fund, thereby withdrawing the employer from participation in the claims reimbursement portion of the surplus fund.

Ohio Employer Incentive Program

Complete this form to apply for the Ohio Incentive Program.

Handicap Reimbursement Election Form

complete this form if you are self-insured and wish to elect to withdraw from the handicap reimbursement program.

Election to obtain coverage in other states

Complete this form if you are planning to obtain insurance in another state.

Self Assessment Business Plan for Safety

Complete the self-assessment to show us how you met the requirements of the 10-Step Business Plan for Safety.

Opt Out of .99 EM Construction Cap Program

Complete this form if you meet the requirements and wish not to participate in the .99 EM Construction Cap Program.

Ten Step Business Plan of Action

Complete this form to present your business plan to the Ohio Bureau of Workers' Compensation.

Workers' Comp Exemption

Each state has its own laws and requirements regarding when and how employers are allowed to opt-out of coverage under their workers compensation policy. Some states make it easier than others because they don't require anything to be filed. Other states require special inclusion or exclusion affidavit documentation. Failure to comply often causes employers to have to pay premium on themselves even when they wanted to be excluded form coverage.

Waiver of Subrogation

A waiver of subrogation means that a business and their insurance company is foregoing all rights to file suit, or seek damages, from another business. This is common in the construction industry as builders attempt to protect their company from negligence. A workers' comp waiver of subrogation does not prevent an injured employee from filing a lawsuit for damages. This coverage typically add about $100 to the cost of a work comp policy.

Certificate of Insurance

A Certificate of Insurance is a document that serves as evidence of insurance or proof of coverage. Certificates indicate your current coverages and policy limits. Insurance Agencies issue on an insured's behalf and they often list a third party as a certificate holder. This means they should be notified if a policy cancels prior to expiration. Requests for any special wording should be carefully checked against the policy language before being added to a certificate as they can create legal issues with coverage.


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State Resources for Ohio

Ohio Bureau of Workers' Compensation

30 West Spring Street
Columbus, OH 43215-2256
800-644-6292
Ohio BWC

Industrial Commission of Ohio

30 W Spring St
Columbus, OH 43215-2233
800-521-2691
Ohio Industrial Commission

Workers compensation insurance is required by law for Ohio employers.

Ohio forms and applications such as owners inclusion or exclusion forms are sometimes updated by the state. Contact us if you need help or can't find the workers compensation form your need for Ohio.

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We've developed Target Programs with key insurance companies that provide bigger discounts and more credits.

Visit NCCI for more resources and information about workers' compensation class codes. Visit United States Department of Labor for more information about government agencies managing workers compensation insurance rates.

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