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OhioBWC - Worker - Form: (R-2) - Introduction
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Authorization of Representative of Injured Worker
(R-2)
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| Introduction |
Injured workers use this form to notify BWC that they've authorized a representative
to act on their behalf in all BWC matters. Completing the R-2 allows authorized representatives
to review files, file paperwork, and interact with BWC personnel.
Once the injured worker signs the R-2, the representative can act as the injured worker’s agent.
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To dismiss an authorized representative, BWC must receive written and signed notification
from the injured worker. According to Ohio Administrative Code 4123-3-22(C),
the injured worker may file a notice with BWC or a new authorization for another representative.
The new R-2 is sufficient notice for BWC to dismiss the former representative.
Upon receipt of a request for dismissal of an authorized representative, the claims service specialist(CSS)
will notify the injured worker that an authorization to receive workers’ compensation checks (POA)
will require a separate written dismissal. The injured worker must also send a written dismissal
to the representative(s). Injured workers may also notify their CSSs of the dismissal of the current
authorized representative by telephone, fax or letter.
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| Required information |
- Representative’s name, mailing address, including city, state, and ZIP code
- The representative's phone number
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| Complete the forms |
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Do you have all the required information at hand? If so, you are ready to begin
completing the form. When completing the online form, please use the previous and next
buttons located at the bottom of the page to navigate
through the form.
Begin online form now.
Are you missing some of the required information? If so, you may return here
at a later time when you have all the information you need, and complete
this online form. Or, you may print a blank copy of the form to complete by
hand and either mail or fax it to BWC.
Print a blank form.
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