Fill out this no obligation form to see if you are eligible for a group rating.
Mail or Fax
If you would rather, you can download the PDF form here, fill it out and mail/fax it back to us at:
Employer Service Department; Ohio Bureau of Workers’ Compensation
c/o CareWorks Comp Inc.
5500 Glendon Court
Dublin, OH 43016
This is to certify that CareWorks Comp Inc. (ID No.150-80)(Code 31/00) including its agents or representatives identified to you by them, has been retained to review and perform studies on certain workers’ compensation matters on your behalf.
Limited letter of authority and authorization
The limited letter of authority provides access to the following types of information relating to your account:
Merit-rated or non-merit rated experiences
Other associated data
This authorization does NOT
include the authority to:
Review protest letters
File protest letters
File form CHP-4
File Motions, I-12’s or IC-88’s
File self-insurance applications
Represent the employer at hearings
Pursue other similar actions on behalf of the employer
I understand that this authorization is limited and temporary in nature and will expire on February 28 or automatically nine months from date received by the Employer Services or Self-Insured Section, whichever is appropriate. In either case length of authorization will not exceed nine months.