Questionnaire for Applicants Requesting Participation in the Workers' Compensation Group Rating Program Administered by Ohio Group Management, LLC
******Please do not complete this form unless you are an employer currently enrolled in Spooner's Group Rating program.******
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Employer entered into an Agreement with Administrator to participate in the Group Rating Program. Employer will be required to complete this Questionnaire for each year Employer would like to participate in the Program. This Questionnaire is for the coming Policy Year.