If you would rather, download the PDF form here, fill it out and mail/fax it back to us at:
Employer Service Department; Ohio Bureau of Workers’ Compensation
c/o CareWorksComp Inc.
5500 Glendon Court
Dublin, OH 43016
This is to certify that CareWorksComp Inc. (ID No.150-80)(Code 31/00) including its agents or representatives identified to you by them, has been retained to review and perform studies on certain workers’ compensation matters on your behalf.