Application for Ohio Workers' Compensation Coverage

What happens next?
Once BWC processes your
application you will receive notice
of:
• A new employer kit explaining
your rights and responsibilities,
and cost savings tips for your
business. The kit includes an
MCO Selection Guide with
instructions on how to select
a manage care organization
to manage the medical part
of your company’s workers
compensation claims; Certificate
of Ohio Workers’ Compensation
Coverage, including the
effective date of coverage,
which is the day BWC received
your signed application and; the
$120 non-refundable application
fee. You must post the Certificate
of Ohio Workers’ Compensation
Coverage as proof of coverage;
• BWC requests 12-month
estimated payroll. The estimated
payroll provided will determine
your estimated annual
premium, which BWC uses to
calculate future installment
payments due.
Coverage is not in effect until BWC receives the completed application and the $120 non-refundable application fee. BWC cannot process incomplete applications.
Workers’ compensation coverage protects you and your employees
in the event of a work-related injury, disease or death. In Ohio,
all employers with one or more employees must carry workers
compensation coverage. It’s the law. Coverage becomes effective when
BWC receives this completed application and the $120 non-refundable
application fee. Independent contractors and subcontractors also must
obtain coverage for their employees.
BWC considers officers of a corporation employees for the purposes
of workers’ compensation; except for an individual incorporated as a
corporation with no employees.
However, if you are self-employed, a partner in a business, an officer of a
family farm corporation or an individual incorporated as a corporation,
you are not automatically covered. You may elect coverage for yourself
by selecting Yes in the elective coverage section and owners/officers/
ministers information section of this application.
Note: Even if you do not elect coverage for yourself you must have
coverage for any employees you hire.
1. Apply for coverage online at www.bwc.ohio.gov, or complete all
fields on this application for coverage;
2. Provide as many details as possible. When describing the nature
of the business, include the type of work performed and the
equipment used;
3. Sign and date the application. It’s not valid without a signature;
4. Mail the completed application with the $120 non-refundable
application fee to: Ohio Bureau of Workers’ Compensation
P.O. Box 15698
Columbus, OH 43215-0698
Please make check or money order payable to the Ohio Bureau of
Workers’ Compensation.
It’s easy to obtain coverage by following these steps:
BWC-7503 (Rev. May 26, 2015) Instruction page 1 of 4
U-3
Application for
Ohio Workers’ Compensation Coverage
Have question? Need assistance? BWC is here to help!
Call 1-800-644-6292, and listen to the options to reach a customer service representative.
You can dial the number nationwide, and in Canada and Mexico from 7:30 a.m. to 5:30 p.m. EST.
Remember, you can access information and request services by visiting BWC’s Web site at www.bwc.ohio.gov.
online form
Ohio law requires employers to obtain workers’ compensation coverage for their employees from the first date of hire. Indicate the
date your employees first earned wages in Ohio or the date you estimate your employees will first earn wages in Ohio. If you do
not provide this information, you may be assessed a penalty for non-covered periods where coverage should have been obtained.
Be sure to supply your federal employer identification number (FEIN). You can obtain a FEIN number by calling the Internal Revenue
Service. If you have applied for a FEIN, but have not received one, write “applied for” in the appropriate box, and you may supply
it at a later date. Domestic household employers, sole proprietors and partnerships who do not need a FEIN should supply a Social
Security number of the sole proprietor, one of the home owners or partners.
BWC uses your primary physical Ohio location to assign one customer service office for all your policy services. Please provide the
address for your primary Ohio location best capable of handling and resolving your policy issues or an out of state location if you
have no physical Ohio location. BWC will send all employer related correspondence including your invoice to the mailing address.
If no mailing address is provided, BWC will use the primary physical Ohio location for all employer notifications.
General Information
Page 1/8
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