MCO Selection Form

Injuried Worker Procedures

Employer Procedures

First Report of an Injury

C-108 Waiver of Appeal

C-11 Treatment Appeal

C-86 Motion

C-94-A Wage Statement

Phone:
440/899-2400 or
800/542-9479

Fax:
440/899-2411 or
800/542-9480

Hours:
8:00 a.m. - 5:00 p.m.

After hours please
leave a detailed
voicemail message

Mailing Address:
28301 Ranney Parkway
Westlake, Ohio 44145

Same Certification. Different Approach.