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Grow Ohio and Group Rating Enrollment

Grow Ohio and Group Rating Enrollment

Your annual participation fee includes enrollment into the group rating program, assistance with managing your workers' compensation claims and representation at one workers' compensation hearing (if necessary).  To enroll in the Group Rating plan through the Grow Ohio Program, please complete the fields below.  Please do not forget to answer the Profile Form questions to enroll into the 2019 Group Rating Plan.

Policy or Application #
Company Name
Officer Name
Title / Position
Phone No
Email
Grow Ohio Enrollment

Group Profile Form - 2019 Group Rating Program

We cannot process online Renewal Forms for Professional Employer Organizations (PEO's)

 If you answer YES to Question 1, Please STOP this form and Call one of our customer service representatives at 866.302.2667

1) Is your company a Professional Employer Organization (PEO) or been affiliated with a PEO in the past 2 years?
 Yes  No
2). In the past 5 years did your company restructure, purchase, merge, or acquire the assets of another Ohio Company?
 Yes  No
If yes, please list the Ohio BWC Policy Number and Entity Name
3). In the past 5 years, has your company done business in Ohio under another BWC policy, other than the one your are enrolling in this plan?
 Yes  No
If yes, please list the Ohio BWC Policy Number and Entity Name
4). Does your company currently have a BWC matter pending before the Court of Common Pleas, the Court of Appeals or the Ohio Supreme Court?
 Yes  No
5). In the coming 18 months, does your company plan to acquire all or part of another Ohio operation or the assets of another Ohio entity?
 Yes  No
Billing Address
Billing Zip Code
Name on Card
Card Type
Card Number
Card Expiration Date
CVV (Security Code)

Before submitting this form, please click on the link below to move the contents of box "A" into box "B" leaving the first box empty.

A: B: Click to Move


 

Certification

By submitting the data above, you are granting permission to Paramount Preferred Solutions, Inc. to enroll your company into the 2019 Group Rating Plan through the Grow Ohio Program and 2019 BWC Group Rating Plan as your authorized BWC representative.  In addition, you are certifying that you are an officer and/or owner of the organization and that all of the information submitted is true to the best of your knowledge, information and belief, after careful investigation.

Please only click submit once. The form may take up to 10 seconds to submit.