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SI-16, Agreement Between Employer and the Ohio Bureau of Workers' Compensation Regarding Amount of Self-Insured Buyout, pdf Print. Agreement Between Employer and the Ohio Bureau of Workers' Compensation Regarding the Amount of Self-Insured Buyout (SI-16) — The employer.The self-insuring employer must post a copy of the Certificate of Employer's Right to Pay Compensation. Agreement Between Employer And The Ohio Bureau Of Workers Compensation Regarding Amount Of Self Insured Buyout {BWC-7216}. For self-insured employers, these claims do not need a BWC claim number, unless Ohio State contests your claim. 5. What is a "Lost Time" claim? SI16: Agreement Between Employer and the Ohio BWC Regarding Amount of SelfInsured Buyout • AC2: Permanent Authorization. Beneficiary - an individual who may become eligible to receive payment due to will, life insurance policy, retirement plan, annuity, trust, or other contract. These are the most frequently requested U.S. Department of Labor forms. You can complete some forms online, while you can download and print all others.