FORM CENTRAL

MinuteMen OhioComp wants to put the forms you need at your fingertips. Just click on any of the forms below to view and print the PDF. If you have questions call us at 1-888-644-6266 or 216-426-0646.

FROI

First Report of Injury.

C-55

Salary Continuation Agreement.

• This form is used to acknowledge an agreement to pay salary/wage continuation in lieu of temporary total or living maintenance compensation

C-101

Authorization to Release Medical Information.

C-110

Employer/Employee Agreement to Select Ohio as the State of Exclusive Remedy for Workers’ Compensation Claims.

MEDCO-14

Physician’s Report of Work Ability.

MEDCO-14 - JOB AIDE FOR PROVIDERS

Provder instructions for completing the Medco-14 form

MINUTEMEN OHIOCOMP INJURED WORKER IDENTIFICATION CARD

Needed when seeking medical treatment.