AC3 - Temporary Authorization to Review Information

By submitting the AC-3 form, you are granting Hunter Consulting permission to obtain your claims history and payroll information from the Ohio Bureau of Workers' Compensation. This information is used to determine your eligibility for participation in a group rating or retrospective group rating program, as well as, to project the premium savings which you would receive should you be accepted into the program. This authorization is temporary in nature and does "not" allow Hunter to represent the employer in any workers' compensation related matters.

Attention Group Rating Prospects:
Employers may complete the AC-3, for as many TPA's or group-rating sponsors as they feel are necessary to obtain quotes for a group-rating program.  Group Sponsors must notify all current group members if they will not be accepted for the next group rating year.  The deadline for this notification is prior to the first Monday in February for private employers and prior to the second Friday in August for public employers.  All potential group-rating prospects must have: Active BWC coverage status as of the application deadline; Active coverage from the application deadline through the group-rating year; No outstanding balances; Operations similar in nature to the other members of their group.  Any changes to a group member's policy will affect the group policy.  Changes can result in either debits or credits to each of the members.

Note:
For complete information on rules for group rating, see Rules 4123-17-61 through 4123-17-68 of the Ohio Administrative code or your TPA.  All group-rating applicants are subject to review by the BWC Employer Programs Unit.

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Should you need assistance filling out the form, or have any group rating questions, please contact Tammy in our sales department at 1-800-486-6652 ext. 114 or tpurcell@hunterconsulting.com.