Ohio
Workers Comp
Employers
Last updated: 4/4/2024
Application For Deductible Program {BWC-7654}
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Description
BWC-7654 -- APPLICATION FOR DEDUCTIBLE PROGRAM. This form is used by the Bureau of Workers' Compensation and allows employers to apply for participation in the Deductible Program, which offers various deductible levels to manage their workers' compensation costs. The form requires policy information, employer contact details, selection of deductible levels, annual aggregate stop-loss option, and submission of financial statements if applicable. It must be signed by an officer, partner, or owner of the business, certifying the accuracy of the information provided and agreeing to comply with the program's rules. www.FormsWorkflow.com
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