Fillable Initial Application for Wage Loss Compensation - OhioBWC

Description
Initial Application for Wage Loss Compensation Instructions File this application when requesting an initial payment of wage loss compensation. Complete the form in its entirety. Provide your physician completing this form with a copy of the functional job description at the time of injury and have him or her complete the medical report. Provide your employer at the time of injury with all copies and attachments....
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