BWC_07012024_to_07012025.pdf
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- Attached to
- Agency Administered OH|407-25-4523
- Contract number
- 407-25-4523
- Issued by
- Ohio
About this file
The document is a Certificate of Ohio Workers' Compensation issued by the Ohio Bureau of Workers' Compensation (BWC) for the policy period of 07/01/2024 to 07/01/2025. The certificate is specifically for an employer named Jamal Naiyer, located at 4924 Sterling Woods Ct. in Dublin, Ohio, with a policy number of 01622329. The certificate verifies the employer's participation in the Ohio State Insurance Fund as required by law.
The certificate confirms the employer's entitlement to rights and benefits of the workers' compensation fund, contingent upon timely payment of premiums and assessments. The document includes a required posting that outlines the legal provisions regarding rebuttable presumption in work-related injury cases, specifically addressing scenarios involving alcohol, marijuana, or controlled substances. The certificate is valid for one year and can be verified online at www.bwc.ohio.gov or by calling 1-800-644-6292. The document emphasizes that the certificate must be conspicuously posted and that the employer can reproduce it as needed.
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Text version
Ohit Bureau ofWorkers Compensation
30 W. Spring St.
Columbus, OH 43215
Certificate of Ohio Workers' Compensation This certifies that the employer listed below participates in the Ohio State Insurance Fund as required by law.
Therefore, the employer is entitled to the rights and benefits of the fund for the period specified. This certificate is only valid if premiums and assessments, including installments, are paid by the applicable due date. To verify coverage, visit www.bwc.ohio.gov, or call 1-800-644-6292.
This certificate must be conspicuously posted.
Policy number and employer 01622329
JAMAL NAIYER
4924 STERLING WOODS CT.
DUBLIN OH 43016
www.bwc.ohio.gov Issued by: BWC
Period Specified Below 07/01/2024 to 07/01/2025
Administrator/CEO You can reproduce this certificate as needed.
Ohio Bureau of Workers' Compensation
Required Posting
Section 4123.54 of the Ohio Revised Code requires notice of rebuttable presumption. Rebuttable presumption means an employee may dispute or prove untrue the presumption (or betief)that atcohot,marihuanaor a controledsubstancenot prescribed by the employee's physician is the proximate cause (main reason) of the work-related injury.
The burden of proof is on the employee to prove the presence of alcohol, marihuana or a controlled substance was not the proximate cause of the work-related injury. An employee who tests positive or refuses to submit to chemical testing may be disqualified for compensation and benefits under the Workers' Compensation Act.
Bureau ofWorkers Compensation You must post this language with the Certificate of Ohio Workers' Compensation.Ohi
DP-29 BWC-1629 (Rev. Jan. 10, 2019)
File details come from the government source that posted it. Updated .