In order to receive a group rating quote for the July 2009 through June 2010 Ohio Workers' Compensation premium year, an AC-3 and company profile form must be completed and submitted to OhioGroupRating.com.
By submitting the AC-3 form, you are giving CPM Risk Management Services temporary authorization to receive the necessary claims history information from the Ohio Bureau of Workers' Compensation, which is used to determine group eligibility status and the premium discount your company may be entitled to.
If you are seeking a quote for more than one company, an AC-3 form must be completed for each individual OBWC policy number.
Should you need any assistance in submitting the AC-3 and company profile form or have any questions, you may contact a member of our support staff at 216-426-2274 or 1-877-873-8856.
Please note that submission of the AC-3 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 216-426-2254. Or you may fill out the online form for faster processing.
Please choose an option below:
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• Easy to fill out
• Confirmation by email
• Faster processing
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