The Ohio Industrial Commission Notice of Appeal, known as Form IC-12 (OIC 1012, Rev. 02/17), is the one-page form you file when you disagree with a workers’ compensation order and want a hearing officer at the Ohio Industrial Commission to review the decision. Injured workers, employers, and their authorized representatives all use this same form to start an appeal.
If your claim was denied or your benefits were cut off, this form is how you fight back. The catch is the clock. You have only 14 days from the date you receive the order to file, and missing that window can end your case before a hearing officer ever hears it. The 14-day appeal deadline is the single most unforgiving rule in the Ohio workers’ comp system, which is why a clean, on-time IC-12 matters so much.
Here is what you will learn in this guide:
- 📝 How to fill out every box on the IC-12, line by line, in plain English
- ⏰ How the 14-day deadline works and how to count it the right way
- 📤 Every way to file the form, including ICON online, fax, mail, and in person
- ⚖️ Three real filing scenarios that walk through the full form from start to finish
- 🚫 The most common mistakes that get appeals delayed, dismissed, or thrown out
What the IC-12 Is and Who Must File It
The IC-12 is the official Notice of Appeal used by the Ohio Industrial Commission to move a disputed workers’ compensation claim to the next hearing level. When the Ohio Bureau of Workers’ Compensation (BWC) or a hearing officer issues an order you do not agree with, this form tells the Commission you want that order reviewed. The form is governed by Ohio’s workers’ compensation appeal statute, R.C. 4123.511, which sets the rules for how and when appeals move through the system.
Three groups file the IC-12. The first is the injured worker, who appeals when a claim is denied or benefits are reduced. The second is the employer, who appeals when a claim is allowed and they believe it should not be. The third is an authorized representative, which can be an attorney or a non-attorney who has been directed to file on a party’s behalf.
The form is short, but its purpose is large. It is the trigger that forces a live hearing in front of a District Hearing Officer (DHO), a Staff Hearing Officer (SHO), or the Commission itself, depending on what order you are appealing. Without a filed IC-12, the order you dislike becomes final, and a final order is very hard to undo.
Legal representation is not required to file. The Commission’s own appeals process page states that hearings are informal and that parties may, but do not have to, hire an attorney or other authorized person. Many injured workers file the IC-12 themselves, which is exactly why this guide breaks down every field.
Before You Start: Documents and Information You Need
Filling out the IC-12 goes faster and cleaner when you gather your paperwork first. The form asks for specific names, dates, and a claim number, and a single wrong digit can send your appeal to the wrong file. Pull these items together before you write anything.
- The order you are appealing. This BWC or hearing officer order tells you what you are appealing and contains the language you will reference. Without it, you cannot correctly identify the order or its date.
- The date you received the order. This date starts your 14-day clock, and guessing it can cost you the appeal. Keep the envelope or the ICON timestamp as proof.
- Your claim number. Every Ohio workers’ comp claim has a unique number, and the Commission files your appeal by this number. A wrong number can attach your appeal to a stranger’s claim.
- Your full legal name and current address. The Commission mails hearing notices here, so an old address means you may miss your own hearing. Use the name on your claim.
- The employer’s name and address. The form has a section for employer information, and the Commission must notify the other side. Missing this can delay service.
- Representative information, if any. If an attorney or authorized person is filing, you need their name, address, phone, fax, and Rep ID number. A missing Rep ID can slow processing.
- A short, clear reason for the appeal. You must state why you disagree, and a blank reason box can lead to confusion about what you want reviewed.
- Any new evidence you plan to submit. The form asks whether you have or intend to file new evidence, and for SHO appeals, failing to identify documents can cause the Commission to decline the appeal.
Having these eight items in front of you means you can complete the IC-12 in one sitting. It also protects you if a deadline is close, since you will not be hunting for a claim number while the 14-day window shrinks.
Where to Get the Form and How to Access It
The IC-12 lives on the Ohio Industrial Commission website, and the most current version is the IC-12 Notice of Appeal PDF, marked OIC 1012 (Rev. 02/17). You can download it, print it, and fill it in by hand or type into the PDF before printing. The same form is also linked from the BWC page on appealing a claim decision.
You do not always need the paper form. The Commission lets you file the appeal entirely online through the Industrial Commission Online Network (ICON), which walks you through the same questions the paper form asks. ICON is the fastest route and gives you a time-stamped confirmation page.
If you cannot reach the website, you can request a copy by phone or email. The Commission’s Customer Service department can mail you a form at 614-466-6136 in the Columbus area or 800-521-2691 toll-free, or by email at askIC@ic.ohio.gov. Always confirm you have the current revision date so an outdated form does not slow your filing.
Check the revision date in the bottom corner before you file. The form should read Rev. 02/17. Using a version that matches what the Commission expects avoids any question about whether your notice was proper.
Step-by-Step: How to Fill Out Form IC-12 Line by Line
The IC-12 fits on one page, but every box has a job. Work through the form top to bottom in the order below, and use the exact field names printed on the form. Each section explains what the box asks, how to answer it, an example, a common edge case, the mistake to avoid, and a myth to drop.
1. Injured Worker Information (Name, Address, City, State, Zip)
This top block asks for the injured worker’s full name and mailing address. Write the name exactly as it appears on the claim, then the street address, city, state, and ZIP code on the lines provided. For example, Maria Lopez writes her name, then 418 Oak Street, then Dayton, OH 45402.
If the injured worker recently moved, use the current address where mail can be received, not the address from the date of injury. The Commission mails every hearing notice to this address, so it must be where you actually get mail today.
A common mistake here is using a nickname or a shortened name that does not match the claim file. That mismatch can cause the appeal to be linked to the wrong record or delayed while staff confirm identity. A frequent myth is that the address does not matter because everything is online; in reality, official hearing notices still go by U.S. mail, so a wrong address can make you miss your hearing.
2. Injured Worker Telephone and Fax
This line asks for the injured worker’s phone number and, if available, a fax number. Enter a phone number where you can be reached during business hours, written as 937-555-0142. The fax line is optional and can be left blank if you do not have one.
If you only have a cell phone, that is fine; use the number you answer most often. The point is to give the Commission a fast way to reach you about scheduling.
The mistake to avoid is listing a disconnected landline or an old work number, which can leave you unreachable when the office needs to confirm a hearing detail. People often believe the phone number is just a formality, but hearing administrators do call parties about continuances and cancellations, so a live number helps.
3. Injured Worker’s Representative Information (Name, Address, Telephone, Fax, Rep ID#)
This block is for the attorney or authorized person filing on the injured worker’s behalf. Enter the representative’s name, mailing address, phone, fax, and the Rep ID# assigned by the Commission. For example, attorney James Carter, Rep ID# 1234567, lists his firm address and direct fax.
If the injured worker has no representative, leave this entire block blank. Filling it in with random information or your own name as the worker can create confusion about who is authorized to receive notices.
The mistake to avoid is leaving out the Rep ID# when a representative is filing, since that number ties the appeal to the registered rep and missing it can slow processing. A common misconception is that a friend or family member can simply sign as a representative; the Commission expects a properly authorized representative, and non-attorney reps must check the special authorization box later on the form.
4. Employer Information (Name, Address, City, State, Zip)
This section identifies the employer connected to the claim. Enter the legal business name and the employer’s mailing address. For example, Riverside Manufacturing LLC, 900 Industrial Parkway, Columbus, OH 43215.
If the worker had more than one employer, list the employer named on the order you are appealing. If the business name changed, use the name on the claim file to avoid a mismatch.
The mistake to avoid is entering a supervisor’s personal name instead of the company’s legal name, which can misdirect the notice the other side must receive. Many filers assume the Commission already knows the employer so this can be skipped, but the form needs it so the opposing party is properly served and the appeal moves forward.
5. Employer’s Representative Information (Name, Address, Telephone, Fax, Rep ID#)
This block is for the employer’s attorney or authorized representative. If you are the injured worker and do not know the employer’s representative, you may leave it blank, because the Commission will serve the employer at the address you provided. If you do know it, enter the name, address, phone, fax, and Rep ID#.
For a self-insuring employer with in-house counsel, the representative’s details go here. This helps the Commission route notices to the right legal contact.
The mistake to avoid is guessing at the employer’s lawyer and entering wrong contact details, which can delay proper service. A common myth is that you must fill in every box on the form; you only complete the blocks that apply to your side and what you actually know.
6. Appealing Order of (Checkboxes)
This is one of the most important parts of the form. You must check the box that identifies whose order you are appealing: BWC Administrator, District Hearing Officer, or Staff Hearing Officer. For example, if a District Hearing Officer denied additional benefits, Maria Lopez checks the District Hearing Officer box.
The level you check controls which hearing happens next. A BWC Administrator order goes to a DHO hearing, a DHO order goes to an SHO hearing, and an SHO order is appealed to the Commission itself.
The mistake to avoid is checking the wrong level, because an appeal aimed at the wrong order can be rejected or routed incorrectly, wasting precious days inside your 14-day window. A frequent misconception is that you appeal “the BWC” in general; you actually appeal one specific order from one specific decision-maker, so the box must match the order in your hand.
7. Appealed by (Injured Worker or Employer)
This field asks who is bringing the appeal. Indicate whether the appealing party is the Injured Worker or the Employer. For example, Riverside Manufacturing LLC indicates the appeal is brought by the Employer.
If a representative is filing, the appeal is still “by” the party they represent, not by the representative personally. Mark the party whose interest is being protected.
The mistake to avoid is leaving this blank, which can create confusion about who is challenging the order. Some filers think this is the same as the “Appealing Order of” box, but they are different; one identifies who wrote the order, and this one identifies who is appealing it.
8. Hearing Location (City)
This box asks for the city where the prior hearing took place, if there was one. Enter the city only, such as Dayton. If you are appealing a BWC Administrator order and no hearing has happened yet, this may be left blank because there is no prior hearing location.
District and staff hearings are usually held at the local office closest to the injured worker’s home, so the city you enter often matches your regional office. This helps the Commission file your appeal with the correct office.
The mistake to avoid is entering a full street address instead of the city, which is not what the field asks for and can cause clutter in the record. A common misconception is that the hearing location sets where your next hearing will be; the next hearing is scheduled by the Commission, and this box simply records where the prior one occurred.
9. Heard On (Date, mm/dd/yyyy)
This field asks for the date of the prior hearing, written in mm/dd/yyyy format. For example, a hearing held on March 4, 2026, is written 03/04/2026. If you are appealing a BWC Administrator order with no prior hearing, this can be left blank.
Use the date printed on the order you are appealing. The order states when the hearing was held, so copy it exactly rather than relying on memory.
The mistake to avoid is using the wrong date format, such as writing the month as a word, which can cause data-entry confusion. People often mix up the hearing date with the date the order was mailed; those are different dates, and this box wants the hearing date.
10. Date Order Received (mm/dd/yyyy)
This is the field that controls your deadline, so handle it with care. Enter the date you actually received the order being appealed, in mm/dd/yyyy format, such as 05/12/2026. Your 14-day appeal window counts from this date under R.C. 4123.511.
If you are unsure of the exact date, the Commission generally presumes receipt a short time after the order’s mailing date, so keep the envelope or any tracking proof. When the order arrives late, documenting the true receipt date protects your right to the full 14 days.
The mistake to avoid is entering today’s date instead of the real receipt date, which can make your appeal look late or shorten your perceived window. A widespread myth is that the 14 days run from the date on the order; the clock actually runs from when you receive it, which is why this box exists.
11. Reason for Appeal
This box asks why you disagree with the order. Write a short, clear statement of what you want reviewed, such as “I disagree with the denial of my claim for a right shoulder injury and request a hearing.” You do not need legal language; plain words are fine.
If you are appealing only part of an order, say so, for example “I appeal only the denial of temporary total compensation.” This focuses the hearing on the issue that matters to you.
The mistake to avoid is leaving this box blank, which can create uncertainty about what you are challenging and slow the process. Many filers believe they must write a full legal brief here; in truth, a clear sentence or two stating your disagreement is enough to put the issue before a hearing officer.
12. New Evidence Question (Yes or No)
This field asks: Have you filed, or do you intend to file, new evidence not available at the last hearing? Check Yes or No. For example, if James Carter plans to submit a new medical report, he checks Yes.
The form carries a clear warning: if you are appealing a Staff Hearing Officer order, failing to identify the necessary documents may result in a decision not to hear the appeal at the Commission level. So for SHO appeals, take this box seriously and be ready to list your documents.
The mistake to avoid is ignoring this question on an SHO appeal, which can directly cause the Commission to refuse the appeal. A common misconception is that you can spring new evidence at the hearing without notice; the form is asking you to flag it now, and for higher-level appeals, that notice can be required.
13. Self-Insuring Employer Payment Certification
This block is completed only by a self-insuring employer. It states whether Compensation / benefits HAVE or WILL be timely paid as mandated by R.C. 4123.511, or whether they WILL NOT be timely paid. The employer checks the box that reflects their position.
If you are an injured worker or a state-fund employer, skip this section entirely; it does not apply to you. Self-insuring employers pay benefits directly, which is why the law requires them to state their payment intent.
The mistake to avoid is a self-insuring employer leaving this blank, which can raise questions about compliance with R.C. 4123.511 payment duties. A common myth is that filing an appeal pauses all payments; certain compensation continues during appeals, so the certification matters.
14. Interpreter and Court Reporter Requests
This section lets you request a hearing interpreter or a court reporter. Check the interpreter box and write the Language Needed if you need translation, such as Spanish. Check the court reporter box if you want a verbatim record. The form notes that checking either box is also a request for extra time for the hearing.
If you are deaf or hard of hearing, request services here so the Commission can arrange them in advance. Asking early gives the office time to schedule the right support.
The mistake to avoid is showing up needing an interpreter without checking this box, which can force a continuance and delay your case. Some people assume the Commission automatically provides interpreters; you must request the service, and doing it on the IC-12 is the cleanest way.
15. Certificate of Mailing (Service on the Other Parties)
This certification states that you mailed copies of the notice to the injured worker’s representative and/or employer’s representative, with a date you fill in. If there is no representative, you certify that you mailed a copy to the injured worker and/or employer directly. For example, James Carter checks the employer’s representative box and writes 05/14/2026 as the mailing date.
This step is about due process. The other side has a right to know an appeal was filed, so you confirm you served them and on what date. When you file online through ICON, the system handles much of this service for you.
The mistake to avoid is signing this certificate without actually mailing the copies, which is a false certification and can create real problems. A common misconception is that the Commission notifies the other side for you on a paper filing; on a mailed IC-12, the appellant is the one certifying service.
16. Non-Attorney Representative Authorization
This box is checked only by a non-attorney representative who has been authorized and directed to file the appeal. The representative checks whether they were directed by the Injured Worker or the Employer. For example, a union representative directed by the worker checks Injured Worker.
If you are the party filing for yourself, or an attorney filing, leave this box alone. It exists to confirm that a non-lawyer has real authority to act for a party.
The mistake to avoid is a non-attorney filing without checking this box, which can call their authority into question. People sometimes think anyone can file for a worker; non-attorney reps must show they were authorized, and this box is how they certify it.
17. Appellant’s Signature and Date
The final fields require the appellant’s signature and the date, in mm/dd/yyyy format. The person bringing the appeal signs the Appellant’s Signature line and dates it, such as 05/14/2026. A representative may sign on behalf of the party they represent.
An unsigned form is an incomplete form. The signature confirms the appeal is real and authorized, and the date helps document timeliness within the 14-day window.
The mistake to avoid is forgetting to sign, which can render the notice defective and cost you time you do not have near the deadline. A common myth is that typing your name in the PDF is never enough; for ICON filings, the electronic submission serves as your signature, but a printed paper form should be signed by hand.
18. Claim Number
The form asks for the Claim Number tied to your workers’ compensation case. Enter it exactly as it appears on your order, including any letters or dashes, such as 24-123456. This number routes your appeal to the correct file.
Double-check this number against your order. A single transposed digit can send your appeal to the wrong claim or leave it unmatched in the system.
The mistake to avoid is guessing the claim number from memory, which can delay or misfile your appeal. Some filers believe their Social Security number is the same as a claim number; it is not, and the Commission needs the specific claim number printed on the order.
Three Filled-Out Examples Using Real Scenarios
Seeing the form completed end to end makes each box clearer. Below are three common scenarios, each following one person through the IC-12.
Scenario 1: Maria Lopez, injured worker appealing a BWC Administrator denial. Maria’s shoulder claim was denied by a BWC order she received on May 12, 2026. She files the IC-12 herself.
| Form Section | What Maria Enters |
|---|---|
| Injured Worker Name | Maria Lopez |
| Address | 418 Oak Street, Dayton, OH 45402 |
| Telephone | 937-555-0142 |
| Injured Worker’s Representative | (left blank, no representative) |
| Employer Information | Riverside Manufacturing LLC, Columbus, OH 43215 |
| Appealing Order of | BWC Administrator (checked) |
| Appealed by | Injured Worker |
| Date Order Received | 05/12/2026 |
| Reason for Appeal | “I disagree with the denial of my right shoulder claim and request a hearing.” |
| New Evidence | Yes |
| Claim Number | 24-123456 |
| Appellant’s Signature / Date | Maria Lopez / 05/14/2026 |
Scenario 2: James Carter, attorney appealing a District Hearing Officer order for an injured worker. A DHO denied temporary total compensation at a hearing in Dayton on March 4, 2026, and the order was received March 20, 2026.
| Form Section | What James Enters |
|---|---|
| Injured Worker Name | Robert Hayes, Dayton, OH 45403 |
| Injured Worker’s Representative | James Carter, Rep ID# 1234567 |
| Appealing Order of | District Hearing Officer (checked) |
| Appealed by | Injured Worker |
| Hearing Location | Dayton |
| Heard On | 03/04/2026 |
| Date Order Received | 03/20/2026 |
| Reason for Appeal | “Appealing the denial of temporary total compensation.” |
| New Evidence | Yes |
| Certificate of Mailing | Employer’s representative, 03/24/2026 |
| Appellant’s Signature / Date | James Carter / 03/24/2026 |
Scenario 3: Riverside Manufacturing, employer appealing a Staff Hearing Officer order. An SHO allowed an additional condition at a Columbus hearing on April 10, 2026, and the employer received the order on April 22, 2026.
| Form Section | What Riverside Enters |
|---|---|
| Injured Worker Name | Robert Hayes, Dayton, OH 45403 |
| Employer Information | Riverside Manufacturing LLC, Columbus, OH 43215 |
| Employer’s Representative | Susan Pratt, Rep ID# 7654321 |
| Appealing Order of | Staff Hearing Officer (checked) |
| Appealed by | Employer |
| Hearing Location | Columbus |
| Heard On | 04/10/2026 |
| Date Order Received | 04/22/2026 |
| Reason for Appeal | “Appealing the allowance of the additional low back condition.” |
| New Evidence | Yes, new medical report identified |
| Claim Number | 24-998877 |
How to File the Completed Form
The Ohio Industrial Commission accepts the IC-12 through four channels. Pick the one that fits your situation, but whatever you choose, file before the 14-day deadline expires.
Online through ICON. This is the fastest option. Log in at the Access ICON page, enter your claim number, and select the appeal type, then answer the same questions the paper form asks. There is no filing fee, processing can take up to three business days, and the system gives you a time-stamped confirmation page you should print and keep as your proof of filing.
By fax. Print and complete the form, write the claim number on the first page, and fax it to your local office or the Commission’s hearing fax line. For appeals of SHO orders, the Commission Level Hearings main fax is 614-466-3374. There is no fee, and your fax confirmation sheet is your proof of filing, so keep it.
By mail or in person. Mail or hand-deliver the completed IC-12 to a local Industrial Commission office, usually the office where the hearing took place, or to the main office at the William Green Building, 30 West Spring Street, Columbus, OH 43215. There is no filing fee. If you mail it, send it with tracking and keep the receipt; if you file in person, ask for a date-stamped copy as proof of filing.
For any channel, there is no charge to file an appeal, and there is no payment method to worry about. The proof you keep, whether an ICON confirmation, a fax sheet, or a mailing receipt, is what protects you if anyone later questions whether you filed on time.
What Happens After You File
Once your IC-12 is filed, the Commission schedules a hearing at the next level. If you appealed a BWC Administrator order, a District Hearing Officer will hear the case, and a DHO hearing is usually set within about 45 days of the filing. If you appealed a DHO order, a Staff Hearing Officer hears it next.
You will receive a hearing notice by mail at least 14 days before the hearing, stating the date, time, location, and the issues in dispute. Hearings are informal and held in small rooms, not a formal courtroom, as the Commission’s appeals process page explains. You may bring documents, medical reports, and witnesses to support your position.
After the hearing, the hearing officer mails a written decision to all parties. If you disagree with that decision, you may have the right to appeal again to the next level within 14 days. An SHO order can be appealed to the Commission, and the Commission may or may not agree to hear it.
For certain “right to participate” decisions, a party may take the case to the local Court of Common Pleas under R.C. 4123.512, generally within 60 days of the final administrative order. That court appeal is a separate process from the IC-12, but it is the path that follows once Commission-level appeals are exhausted.
Mistakes to Avoid When Filling Out the IC-12
Small errors on this form cause big delays. Watch for each of these.
- Missing the 14-day deadline. A late appeal is usually barred, and the underlying order becomes final.
- Entering the wrong “Date Order Received.” A wrong date can make a timely appeal look late and put your filing at risk.
- Checking the wrong “Appealing Order of” box. An appeal aimed at the wrong order level can be rejected or misrouted.
- Wrong or missing claim number. The appeal can be misfiled or left unmatched in the system.
- Leaving the Reason for Appeal blank. This creates confusion about what you want reviewed and can slow the process.
- Ignoring the new-evidence question on an SHO appeal. Failing to identify documents can lead the Commission to refuse the appeal.
- Forgetting to sign and date the form. An unsigned paper notice can be treated as defective.
- Using an old mailing address. You may miss the hearing notice and lose your chance to be heard.
- Falsely certifying the mailing of copies. Signing the service certificate without mailing can create serious credibility problems.
- Keeping no proof of filing. Without a confirmation, fax sheet, or receipt, you cannot prove you filed on time.
- Self-insuring employer skipping the payment certification. This can raise questions about compliance with R.C. 4123.511.
- Guessing the employer’s representative details. Wrong contact info can delay proper service on the other side.
Do’s and Don’ts
A few simple habits keep your appeal on track.
Do:
- Do file as soon as you get the order, since waiting only burns your 14 days.
- Do write the claim number on every page you fax or mail, so nothing gets separated.
- Do keep your proof of filing, because it is your defense if timeliness is questioned.
- Do use the current Rev. 02/17 form, so there is no question about its validity.
- Do state a clear reason for appeal, which helps the hearing officer focus on your issue.
- Do update your address if you moved, so you actually receive your hearing notice.
Don’t:
- Don’t guess the date you received the order, since that date controls your deadline.
- Don’t leave required boxes blank, because incomplete forms get delayed.
- Don’t certify mailing copies you never sent, as a false certificate can backfire.
- Don’t appeal the wrong order level, which can get your filing rejected.
- Don’t wait for the mail if the deadline is close; file through ICON for speed.
- Don’t assume someone else served the other side on a paper filing; you certify that.
Filing on Your Own vs. With Help
Many injured workers file the IC-12 themselves, while others hire an attorney. Each path has trade-offs.
Pros of filing on your own:
- It costs nothing, since there is no filing fee and no attorney fee.
- The form is short and the ICON system guides you, so it is doable solo.
- You control your own timeline and can file the moment you get the order.
- Hearings are informal, so you do not need courtroom experience to be heard.
- You learn your own case well, which helps you explain it at the hearing.
Cons of filing on your own:
- You may misjudge which order level to appeal or miss a key deadline.
- You might not know what new evidence will strengthen your case.
- A self-represented filer can struggle to counter an employer’s lawyer.
- Mistakes on the form can delay the hearing you need quickly.
- You carry the full burden of proof and presentation alone.
For complex claims, denied surgeries, or appeals against a self-insuring employer with counsel, professional help often pays off. For a simple, clearly documented appeal filed well before the deadline, many workers handle the IC-12 on their own without trouble.
IC-12 vs. ICON Online Filing
Both methods start the same appeal, but they differ in speed and proof.
| Feature | Paper IC-12 (Mail/Fax) | ICON Online Filing |
|---|---|---|
| Speed | Depends on mail or fax delivery | Immediate submission |
| Proof of filing | Fax sheet or mailing receipt you keep | Printable time-stamped confirmation page |
| Cost | No fee | No fee |
| Service on other party | You certify mailing copies | System assists with service |
| Best for | Filers without online access | Filers who want the fastest, tracked option |
FAQs
Do I have to file the IC-12 within 14 days?
Yes. You must file within 14 days of the date you receive the order under R.C. 4123.511. Missing this deadline usually makes the order final and ends your appeal.
Can I file the IC-12 online instead of on paper?
Yes. You can file the full appeal through ICON, which asks the same questions and gives a time-stamped confirmation. It is the fastest filing option available.
Is there a fee to file the Notice of Appeal?
No. The Ohio Industrial Commission charges no fee to file the IC-12 by any channel, including ICON, fax, mail, or in person. There is no payment to submit.
Do I write the date the order was mailed in “Date Order Received”?
No. Write the date you actually received the order, not the mailing date. Your 14-day clock runs from receipt, so the receipt date is what belongs in that box.
Which box do I check under “Appealing Order of”?
Yes, you must check exactly one: BWC Administrator, District Hearing Officer, or Staff Hearing Officer. Check the box that matches the specific order you are appealing.
Do I need to fill in the employer’s representative section?
No. Leave it blank if you do not know the employer’s representative; the Commission will serve the employer at the address you list. Only complete blocks that apply and that you know.
Must I list a claim number on the form?
Yes. Enter the claim number exactly as it appears on your order, including dashes. A wrong or missing number can misfile your appeal or leave it unmatched.
Do I need a lawyer to file the IC-12?
No. Legal representation is not required, and hearings are informal, as the Commission’s appeals process page explains. You may hire an attorney, but many workers file on their own.
Should I check “Yes” on the new-evidence question for an SHO appeal?
Yes, if you have or plan to submit new evidence, and you should identify it. For SHO appeals, failing to identify documents can lead the Commission to refuse the appeal.
Do I have to sign the paper form?
Yes. A paper IC-12 must be signed and dated by the appellant or their representative. An unsigned notice can be treated as defective and put your timing at risk.
Can a non-attorney file the appeal for me?
Yes, but the non-attorney representative must check the authorization box confirming the worker or employer directed them to file. Without that, their authority can be questioned.
Do I have to mail copies to the other side myself?
Yes, on a paper filing you certify that you mailed copies to the representatives or parties and write the date. When you file through ICON, the system assists with service for you.
Can I appeal the hearing officer’s decision after the IC-12 hearing?
Yes. You can usually appeal to the next level within 14 days, and certain final decisions can go to the Court of Common Pleas under R.C. 4123.512 within 60 days.
Does filing the IC-12 stop my benefit payments?
No. Filing an appeal does not automatically stop all payments; certain compensation continues during appeals under R.C. 4123.511, and self-insuring employers must certify their payment intent.
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