Forms & Claim Documents
All our forms are available for downloading here. You may file some of them online via ICON. If you would like to request that a
specific form be sent to you, contact our Customer Service Department via email at askIC@ic.ohio.gov or by phone 614-466-6136
(Columbus area) or 800-521-2691 (toll-free).
You may mail or fax forms to your local Ohio Industrial Commission office or to the Customer Service department.
The Ohio Industrial Commission website is currently unable to accept forms via email. Some of our forms are available via ICON, and those submissions will be accepted through our online system. The IC discourages sending documents by email as some environments are not secure.
The following forms may be submitted via ICON:
- IC-12 Notice of Appeal
- IC-167-T Objection to Tentative Order
- IC-50 Request for Cancellation
- IC-51 Request for Continuance
- IC-52 Request for .522/52 Relief
- IC-INT Request for Interpretive Services
Log In To ICON
Injured Workers: If you log in with a password, enter your claim number in the Access Your Claim section and click Submit. Click the Submit a Request/Appeal button. If you log in without a password, click the Submit an Appeal/Objection button.
Employer and Representatives: After you log in, enter your claim number in the Submit a Request/Appeal section and click Submit.
From there, click the applicable Appeal, Objection or Relief button.
Provide Appeal/Objection/Relief Information
You may need to have your IC or BWC correspondence to provide some of the information requested. You must provide answers to all the claim-related questions in order to successfully submit the appeal/objection/relief. Email addresses are optional. If you have specific questions about the form or information requested, please contact Customer Service for assistance.
Verify Appeal/Objection/Relief Information
Before submitting the appeal/objection, make sure the information you provided is correct. You can make corrections by selecting the Revise button. Once you are satisfied that the information is true and correct, select Submit to forward the appeal/objection to the IC.
Submission Confirmation
The final page of the online appeal/objection/relief process provides confirmation of your submission. You should print a copy of this confirmation page for your records, as it contains all the information you provided as well as a time/date stamp indicating when it was submitted. You do not need to file / upload this information in the claim. If you provided an email address, you will receive a confirmation email once the appeal/objection/relief has been processed. Appeal/Objection/Relief processing could take up to three business days.
Injured Workers: If you log in with a password, enter your claim number in the Access Your Claim section and click Submit. Click the Submit a Request/Appeal button. If you log in without a password, click the Submit an Appeal/Objection button.
Employer and Representatives: After you log in, enter your claim number in the Submit a Request/Appeal section and click Submit.
From there, click the applicable Appeal, Objection or Relief button.
Provide Appeal/Objection/Relief Information
You may need to have your IC or BWC correspondence to provide some of the information requested. You must provide answers to all the claim-related questions in order to successfully submit the appeal/objection/relief. Email addresses are optional. If you have specific questions about the form or information requested, please contact Customer Service for assistance.
Verify Appeal/Objection/Relief Information
Before submitting the appeal/objection, make sure the information you provided is correct. You can make corrections by selecting the Revise button. Once you are satisfied that the information is true and correct, select Submit to forward the appeal/objection to the IC.
Submission Confirmation
The final page of the online appeal/objection/relief process provides confirmation of your submission. You should print a copy of this confirmation page for your records, as it contains all the information you provided as well as a time/date stamp indicating when it was submitted. You do not need to file / upload this information in the claim. If you provided an email address, you will receive a confirmation email once the appeal/objection/relief has been processed. Appeal/Objection/Relief processing could take up to three business days.
Log In To ICON
Injured Workers: After you log in, enter your claim number in the Access Your Claim section and click Submit. Click the Submit a Request/Appeal button.
Employer and Representatives: After you log in, enter your claim number in the Submit a Request/Appeal section and click Submit. You can also visit your employer or representative calendar, click on a hearing date requiring the request and then select the claim number.
From there, click the Request a Service button and then select the applicable request (Continuance, Cancellation, etc.).
Provide Request Information
You may need to have your IC or BWC correspondence handy to provide some of the information requested. You must provide answers to all the claim-related questions in order to successfully submit the request. Email addresses are optional. If you have specific questions about the form or information requested, please contact Customer Service for assistance.
Verify Request Information
Before submitting the request, make sure the information you provided is correct. You can make corrections by selecting the Revise button. Once you are satisfied that the information is true and correct, select Submit to forward the request to the IC.
Submission Confirmation
The final page of the online request process provides confirmation of your submission. You should print a copy of this confirmation page for your records, as it contains all the information you provided as well as a time/date stamp indicating when it was submitted. You do not need to file / upload this information in the claim. If you provided an email address, you will receive a confirmation email once the request has been processed. Request processing could take up to three business days.
A note regarding filing deadlines:
Although requests may be submitted online at any time, they are processed according to normal IC business hours. Online requests cannot be submitted less than two days before the hearing. If you require a continuance for a hearing that is less than two days away, please contact the Regional Hearing Administrator.
A note regarding Interpreter and Additional Time Requests:
These can also be requested when subitting an Appeal or Objection.
Injured Workers: After you log in, enter your claim number in the Access Your Claim section and click Submit. Click the Submit a Request/Appeal button.
Employer and Representatives: After you log in, enter your claim number in the Submit a Request/Appeal section and click Submit. You can also visit your employer or representative calendar, click on a hearing date requiring the request and then select the claim number.
From there, click the Request a Service button and then select the applicable request (Continuance, Cancellation, etc.).
Provide Request Information
You may need to have your IC or BWC correspondence handy to provide some of the information requested. You must provide answers to all the claim-related questions in order to successfully submit the request. Email addresses are optional. If you have specific questions about the form or information requested, please contact Customer Service for assistance.
Verify Request Information
Before submitting the request, make sure the information you provided is correct. You can make corrections by selecting the Revise button. Once you are satisfied that the information is true and correct, select Submit to forward the request to the IC.
Submission Confirmation
The final page of the online request process provides confirmation of your submission. You should print a copy of this confirmation page for your records, as it contains all the information you provided as well as a time/date stamp indicating when it was submitted. You do not need to file / upload this information in the claim. If you provided an email address, you will receive a confirmation email once the request has been processed. Request processing could take up to three business days.
A note regarding filing deadlines:
Although requests may be submitted online at any time, they are processed according to normal IC business hours. Online requests cannot be submitted less than two days before the hearing. If you require a continuance for a hearing that is less than two days away, please contact the Regional Hearing Administrator.
A note regarding Interpreter and Additional Time Requests:
These can also be requested when subitting an Appeal or Objection.
Forms Submitted via Mail or Fax
The Ohio Industrial Commission does not provide confirmation of receipt of forms sent through mail or fax. If you question whether your forms have been received you may contact a Customer Service Representative via email at AskIC@ic.ohio.gov or by phone 614-466-6136 (Columbus area) or 800-521-2691 (toll-free) to verify receipt of your document.
Forms Submitted Electronically via ICON
The last page of the online submission process is a Confirmation page. This page contains all the information you submitted as well as a time/date stamp. If you receive a confirmation page, the IC received your submission. Print a copy of the confirmation page as a receipt of your filing. You do not need to file / upload this information in the claim. If you provided an email address, you will receive a confirmation email once the request has been processed. Request processing could take up to three business days.
*If an appeal has been filed either online or through mail or fax, all parties will receive a Notice of Hearing.
The Ohio Industrial Commission does not provide confirmation of receipt of forms sent through mail or fax. If you question whether your forms have been received you may contact a Customer Service Representative via email at AskIC@ic.ohio.gov or by phone 614-466-6136 (Columbus area) or 800-521-2691 (toll-free) to verify receipt of your document.
Forms Submitted Electronically via ICON
The last page of the online submission process is a Confirmation page. This page contains all the information you submitted as well as a time/date stamp. If you receive a confirmation page, the IC received your submission. Print a copy of the confirmation page as a receipt of your filing. You do not need to file / upload this information in the claim. If you provided an email address, you will receive a confirmation email once the request has been processed. Request processing could take up to three business days.
*If an appeal has been filed either online or through mail or fax, all parties will receive a Notice of Hearing.
Log in to ICON. After you log in:
Documents can be moved to the hearing folder by clicking the check box to the left of the document and then clicking the button at the bottom of the screen, ADD TO HEARING FOLDER.
Documents can be categorized and viewed by class and document type. Documents can also be sorted by clicking the underlined column headings.
To view documents for heardwith and reference claims
Select the hearing folder you wish to view by choosing it from the SELECT FOLDER VIEW dropdown. From the Hearing Folder View, double-click on the claim number you wish to view to the right of the dropdown, either in the HW or REF fields.
To return to the original claim, click the RETURN TO ENTERED CLAIM button.
Please Note: If you are not a party to the claim you wish to view, you must first navigate to the HEARING FOLDER VIEW of a claim you are a party to before proceeding to the heardwith or reference claim documents.
- For Injured Workers, enter your claim number in the ACCESS YOUR CLAIM section.
- For Employers and Representatives, enter the claim number, SSN or the inured worker's last name and first initial in the FIND A CLAIM section.
Documents can be moved to the hearing folder by clicking the check box to the left of the document and then clicking the button at the bottom of the screen, ADD TO HEARING FOLDER.
Documents can be categorized and viewed by class and document type. Documents can also be sorted by clicking the underlined column headings.
To view documents for heardwith and reference claims
Select the hearing folder you wish to view by choosing it from the SELECT FOLDER VIEW dropdown. From the Hearing Folder View, double-click on the claim number you wish to view to the right of the dropdown, either in the HW or REF fields.
To return to the original claim, click the RETURN TO ENTERED CLAIM button.
Please Note: If you are not a party to the claim you wish to view, you must first navigate to the HEARING FOLDER VIEW of a claim you are a party to before proceeding to the heardwith or reference claim documents.
Filing Options and Guidelines:
The following guidelines will help ensure documents are placed in the correct electronic hearing folder on a timely basis (within 24 hours after submission).
The following guidelines will help ensure documents are placed in the correct electronic hearing folder on a timely basis (within 24 hours after submission).
- The BWC and IC exchange imaged documents when there is a contested issue. Therefore, if a document has been filed at one agency, it is not necessary to file it with the other. Filing with both agencies clutters the electronic file with duplicate documents. In addition, if you submit documents for a DHO hearing, it is not necessary to resubmit the same documents for the SHO hearing.
- Documents can be submitted directly to the IC using the following options:
- Upload documents directly into the OIC’s claim file utilizing ICON (available for Reps ONLY). For more information on this option, please call the OIC IT Helpdesk at 877-218-4810;
- Mail or hand deliver documents to an IC district or regional office; or
- Fax documents to an IC district or regional office. For a list of fax numbers check the IC Fax Numbers page.
- Place the claim number on the first page of each document, in the upper right hand corner (if possible). A single copy is sufficient.
- By definition, the IC classifies a "document" as original paper with information that has never been seen (scanned) by or was not created by the IC or BWC.
- Use 8 ½ x 11 white paper. Legal size, colored paper and highlighted documents do not scan / upload properly.
- Submit documents on IC/BWC forms obtained though the IC/BWC websites.
- Submit documents as you receive them so they can be imaged and reviewed prior to hearing.
- Submit documents that are legible to ensure readability. Pay attention to font size and copy quality.
- Documents submitted to the IC one day prior to hearing or on the day of hearing are held for the hearing officer’s review and will be imaged after the hearing.
- Hearing Administrator documents, listed below, should be filed directly with hearing administrator’s office for expedited processing. File these documents on ICON or fax to the HA’s office. For a list of fax numbers check the IC Fax Numbers page.
- Continuance or Cancellation requests
- Pre-hearing conference requests
- Motions for relief pursuant to .522 / .52
- Extension requests for PTD claims
- Subpoena/Deposition/Suspension requests
- All medical documents are separated by provider, date of service and document type so they are easy to locate and access in the electronic hearing folder. Please keep this information in mind when submitting medical documents.
- Utilize IC/BWC forms obtained through our websites when applicable.
- When reviewing the electronic hearing folder, you may see “Entire Document Split.” This means we have split the documents previously scanned or uploaded together into the correct document type and have indexed them so they are easily identifiable.
Videos and high resolution photos are considered Hard Copy Evidence (HCE) and is something that cannot be uploaded via the ICON web site.
HCE can be submitted via discs or flash drives.
Any HCE submitted to an IC district office will continue to be accepted.
The most expeditious process to process Hard Copy Evidence is to submit directly to Customer Service at the Columbus Office located at 30 West Spring Street, Columbus, OH 43215-2233.
HCE can be submitted via discs or flash drives.
Any HCE submitted to an IC district office will continue to be accepted.
The most expeditious process to process Hard Copy Evidence is to submit directly to Customer Service at the Columbus Office located at 30 West Spring Street, Columbus, OH 43215-2233.
All Parties
Reps & Employers