Ohio > Workers Comp > Employers
Application For Ohio Workers Compensation Coverage U-3 - Ohio
| Application For Ohio Workers Compensation Coverage Form. This is a Ohio form and can be used in Employers Workers Comp . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
Application for Ohio Workers' Compensation Coverage Have questions? Need assistance? BWC is here to help! Call 1-800-OHIOBWC, 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 ohiobwc.com 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 for Ohio employers and their employees (i.e., employees whose contracts of hire have been consummated within the borders of Ohio, whose employment involves activities both within and without the borders of Ohio and where the supervising office of the employer is located in Ohio), becomes effective when BWC receives this completed application and the $10 minimum security deposit. 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 (to qualify must have a single/sole owner 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. What happens next? Once BWC receives your application for coverage you will receive: · A new employer kit explaining your rights and responsibilities, and cost-saving tips for your business. The kit includes: an MCO Selection Guide with instructions on how to select a managed care organization to medically manage your company's workers' compensation claims; Certificate of Premium Payment, including the effective date of coverage, which is the day BWC receives your signed application and $10 deposit; and your seven-digit identification number called a BWC policy number. Please use it whenever you contact BWC about your policy. Remove the Certificate of Premium Payment and post it as proof of coverage; · An invoice for the difference between the $10 minimum security deposit and the additional security deposit you owe. The security deposit is 30 percent of your estimated eight months' premium up to a maximum of $1,000. Your security deposit will not be applied to future premium. It's easy to obtain coverage by following these steps: 1 Apply for coverage online at ohiobwc.com, 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 Detach and mail the completed application with a $10 minimum security deposit 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, or if you prefer, you may charge the minimum security deposit to your VISA®, MasterCard® or American Express®. Coverage is not in effect until BWC receives the completed application and the $10 minimum security deposit. BWC is unable to process incomplete applications. U-3 BWC-7503 Instructions Revised 4/12/2007 Instruction page 1 of 4 American LegalNet, Inc. www.FormsWorkflow.com Completing the Application for Ohio Workers' Compensation Coverage General information completed by all employer types Ohio law requires employers to obtain workers' compensation coverage for their employees from the first date of hire. Indicate the date you first hired one or more employees in Ohio or the date you estimate you will hire one or more employees in Ohio. If you do not provide this information, BWC may bill you for two years of prior-to-coverage premium. 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, or one of the home owners or partners. BWC uses your primary physical Ohio location to assign one customer service office for all your risk-management services. Please provide the address for your primary Ohio location best capable of handling and resolving your risk-management issues or an out of state location if you have no physical Ohio location. Business entity information Select the one business entity type that applies to your company. For workers' compensation purposes, there are four possible business entity types that apply to a corporation (i.e., limited liability company acting as a corporation, corporation, individual incorporated as a corporation with no employees and family farm corporation). Select the business entity type that best describes your corporate structure. Domestic household coverage: Applies to full or part-time domestic workers employed inside or outside your private residence and includes private chauffeurs. Domestic household employers who pay workers $160 or more in a calendar quarter must have workers' compensation insurance. Normally these workers provide domestic services, such as gardening, housekeeping, babysitting, etc. However, you should include workers you hire as employees to provide home improvement for construction type activities to your residence if the worker does not have his or her own business or own workers' compensation insurance. Please check the appropriate box under Domestic household employer that applies to the type of worker you will hire, and supply an eight-month payroll estimate so BWC may calculate your premium security deposit. If you are hiring a contractor to perform these services, you may want to verify he or she has active workers' compensation coverage. Sole proprietors and partners (including limited liability companies acting as a sole proprietor or partnership): Sole proprietors and partners are exempt from workers' compensation coverage. However,
|
|||||||
