BRECKS

 Richfield Chamber of Commerce Workers' Compensation Program

Obtain A Free No Obligation Analysis 

Baylor Associates administers a workers' compensation management program for the Richfield Chamber of Commerce. By examining data provided by the Ohio Bureau of Workers' Compensation, we can provide an analysis, which will show the savings that you may realize through participation in various cost cutting plans including: Group Rating, Retrospective Rating, Drug-Free Workplace, Deductibles, 100% Experience Modification Capping, One Claim, 15K Medical Only and Self-Insurance.

To see which plan or combination of plans best serves you, please complete the Form AC-3 Temporary Authorization using the link shown below:

There are four options; 1) Compete the AC-3 form online; 2) Download the form, print it and fax it to Baylor; 3) Print the form and mail it to Baylor or 4) you can just call us to initiate the quote.

4 Complete the AC-3 Form Online

 1.  Click on the link above to load and view the AC-3 temporary authorization form.

 2.  Complete the AC-3 form by clicking on the data fields and typing your information.

 3.  Today's date will be auto-populated.

 4.  Once you have completed the form in its entirety, please print the form for you records.

 5.  You will receive a confirmation email that you must respond to in order to start the ||||||||process. 

4 Or Download and Print a Blank Form to Complete and Fax

 1.  Click on the link above to download and print the PDF Form

 2.  If you need to download the most recent free Adobe PDF Reader Click Here

 3.  Complete the form and fax it back to Baylor Associates at (440) 546-7601.

      Need Help? Please call us at 1-800-433-1922