In order to receive a group rating quote for the July 2007 through June 2008 Ohio Workers' Compensation rating year, a TEMPORARY AUTHORIZATION TO REVIEW INFORMATION form (AC-3) must be completed and submitted to GroupRating.com.

By submitting the AC-3 form, you are giving Workers' Compensation Management Solutions temporary authorization to receive the necessary claims and payroll history from the Ohio Bureau of Workers' Compensation, which is used to determine group eligibility and the premium discount your company may be entitled to.

If you are seeking quotes for multiple companies, an AC-3 form must be completed for each individual Ohio BWC policy number.

Should you need any assistance in submitting the AC-3 form or have any questions, you may contact a member of our support staff at 1-888-626-9267.

Please keep in mind that your submission of the AC-3 form does not guarantee group enrollment and/or premium discount.

There are two ways to fill out the required forms. You may download the printable PDF form, fill it out, and fax it back to us at 216-520-6376. Or you may fill out the online form for faster processing.

Please choose an option below:

OR

• Easy to fill out • Confirmation by email • Faster processing