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Please complete the requested information listed below and click on the submit button.

A representative from SuretyHR will provide you with a no-cost, no-obligation review of your Ohio Workers' Compensation policy. We will identify any ways SuretyHR can help your company save time and money on your workers' comp.

Your submission of this form will certify that SuretyHR including its agents or representatives identified to you by them, has been retained to review and perform studies on certain workers' compensation matters on our behalf.

The limited letter of authority provides access to the following types of information relating to our account:
  1. Risk files;
  2. Claim files;
  3. Merit-rated or non-merit-rated experiences;
  4. Other associated data.
This authorization does not include the authority to:
  1. Review protest letters;
  2. File protest letters;
  3. File form Application for Handicap Reimbursement (CHP-4);
  4. Notice of Appeal (IC-12) or
  5. Application for Permanent Partial Reconsideration (IC-88);
  6. File self-insurance applications;
  7. Represent the employer at hearings;
  8. Pursue other similar actions on behalf of the employer.
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