“They have an experienced, courteous, and professional staff, and they have helped our company to effectively manage our workers’ compensation claims and control our premium costs.”
John S. Santisi – President
Phoenix Supermarkets, Inc.
OVERVIEW
- Services
- Cost Management
- BMSO vs. MCO vs. BWC vs. IC
  - Workers' Compensation Responsibility Chart
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CLAIMS PROCEDURES
- Rate Evaluations
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PROGRAMS
- 50/50 Payment Plan
- Drug-Free EZ
- Group Rating
  - AC3 Form
  - Group Rating Selection Guide
- Light Duty, Modified Duty, Transitional Work Program
- One Claim Program
- Premium Discount
- Premium Discount Plus
- Safety Management
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THE OHIO CHAMBER ALLIANCE, INC.
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GLOSSARY OF TERMINOLOGY
- Workers' Compensation Terminology
- Claims Administration Definitions
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PROCEDURE FOR PARTIAL PAYMENT OF PREMIUM
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WAGE CONTINUATION PROGRAM
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$15,000 MED ONLY PROGRAM
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SELF-INSURED EMPLOYERS
- SI Programs
- SI Guide
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MCO
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LEGISLATIVE UPDATES
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CAREER OPPORTUNITIES
- Positions Available
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CONTACT US
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AFFILIATES
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EVENTS / NEWS
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Contact BWC

 

PROGRAMS - GROUP RATING - AC-3 FORM INFORMATION

Only 3 Easy Steps To Apply For Workers' Compensation Discounts By Submitting An AC-3 Form:

1. Fill out all information below:

Policy Number:
Company Name:
DBA:
Name:
Title:
Address:
City:
State:
Zip:
Phone #:
Fax #:
Email:

2.  Click on the "AC-3 Form" button.  This will bring up the AC-3 form on the next screen.

3.  Print and sign the AC-3 form and fax to BMSO.  Fax number can be found on the
     AC-3 form.  Use the browser "BACK" button to return to this page.

 

 

 

 
 
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