An injured worker applying to the Industrial Commission of Ohio for permanent total disability (PTD) files the IC-2 application, and it must attach or identify a physician's report supporting the claim. There is no prescribed physician form: the clinician writes a narrative report based on an examination performed within 24 months before the application is filed. Without proper medical evidence, the Commission dismisses the application without a hearing.
The treating or examining physician writes the whole report as a narrative. The injured worker or representative completes and signs the IC-2 itself, which lists the physician's name and exam date for each supporting report.
The issuer sets what the letter or report must contain; check its current rules before you write it.
Medical report supporting Application for Compensation for Permanent Total Disability
There is no form to fill: the program asks for a letter or report with the content it sets. Vero Scribe writes the visit note it draws on, so the details are ready when you write it.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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No. The Industrial Commission does not prescribe a physician form for permanent total disability. The physician prepares a narrative report from an examination, and the injured worker attaches it to the IC-2 Application for Compensation for Permanent Total Disability or identifies it on the IC-2 if it is already on file in the claim.
The medical examination on which the report is based must have been performed within twenty-four months before the date the IC-2 is filed. The IC-2 asks for the date of each supporting exam and the physician's name, so the report should state the examination date clearly.
If proper medical evidence is not filed with the IC-2 or identified as already in the claim file, or the application otherwise fails the filing requirements of Ohio Adm.Code 4121-3-34, the Industrial Commission dismisses the application without a hearing.