Completion of the temporary authorization provides a third-party administrator (TPA) limited
authority to view an employer’s payroll and loss experience. By signing the AC- 3, the employer grants
permission to the BWC to release information to the employer’s authorized representative(s). The
form allows a third-party representative to view an employer’s information regarding payroll, claims
and experience modification.
Attention group rating prospects:
• Employers may complete the AC- 3, for as many TPAs 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.
