Election To Withdraw From Claims Reimbursement Fund
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Election To Withdraw From Claims Reimbursement Fund Form. This is a Ohio form and can be use in Employers Workers Comp.
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Tags: Election To Withdraw From Claims Reimbursement Fund, BWC-7244, Ohio Workers Comp, Employers
30 W. Spring St. Columbus, OH 43215-2256 Dear Self-Insuring Employer: Effective June 30, 2006, self-insuring employers may elect to withdraw from the claims reimbursement fund as amended by Senate Bill 7 (SB7). BWC will no longer assess employers exercising this option the portion of the surplus fund assessment for claims reimbursement costs. Note: An employer's decision to elect to withdraw from the claims reimbursement fund is irrevocable. BWC USE ONLY Employer SIDN application number On behalf of the above-referenced employer, I hereby elect to withdraw from the claims reimbursement fund, thereby withdrawing the employer from participation in the claims reimbursement portion of the surplus fund. I understand there will be no reimbursement for claims expenses incurred on or after the effective date of the application. My signature below certifies I am empowered to make this election on behalf of this self-insuring employer under the workers' compensation laws of Ohio. Signature Title Date BWC-7244 SI-44 American LegalNet, Inc. www.FormsWorkFlow.com
