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OhioBWC - Employer:  (Step-by-step instructions to complete the U-20: Private employers)

Step-by-step instructions to complete the U-20:
Private employers

  1. You must include both your federal identification and policy numbers on this form.
  2. Enter your company name and telephone number. Also, enter city, state and nine-digit ZIP code.
  3. Parameter selections
    You must select one of the following individual-retrospective rating plan parameters. Your selection will determine the minimum and maximum level, as well as the exposure to claims losses. Choose one claim limit and one maximum premium limit from the following Tier I parameters:

    Tier I parameters

    • Claim limit: $100,000, $200,000, $300,000, $400,000, no claim limit;
    • Maximum premium: 150 percent or 200 percent.


    Tier II parameters
    If you do not meet the requirements for Tier I do you want to be considered for Tier II?

    If so, choose one of the following claim limits: $100,000 or $125,000. Tier II offers a maximum premium of 150 percent.

    Tier II eligibility requirements are the same as Tier I except if you have entered into any partial payment arrangements with BWC, this will not preclude you from being considered for individual-retrospective rating.
  4. Estimated policy year payroll - Provide estimated payroll you will report during the policy year for each manual classification assigned to your policy number. The private employer policy year is July 1 to June 30.
    Use National Council on Compensation Insurance (NCCI) manual classification numbers, or we will reject your application.
  5. Payroll rounded to the nearest thousand dollars (List all NCCI manual classifications below.)
    NCCI Payroll NCCI Payroll NCCI
    Manual number Manual number Manual number
    *You can access additional pages if necessary for manual classifications
    Owner partner officer

    1. Statement of agreement: I have read the individual-retrospective rating rules in their entirety. I understand the rules and agree with the terms of the individual-retrospective rating plan.
    2. Note: BWC must review and approve the application before it becomes effective. We will notify you in writing when the application is approved and the applicable minimum premium percentage.

      * If you are applying for the first time, you must submit five years of audited financial information. If you are reapplying, you only need to submit the previous year’s audited financial statement. Mail this information within five calendar days to:

      BWC
      Employer programs
      30 W. Spring St., 22nd floor
      Columbus, OH 43215-2256


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