San Allen claim form due 10/22/14

If you got a letter in August from San Allen Inc v, Bureau of Workers’ Compensation and you are entitled to a refund, your claim materials must be postmarked by Wednesday, October 22, 2014.

Step One:  Fill out the form, using the company name  and policy number used in 2001-2008, plus your current mailing address, title, and business phone number.  Your email address is optional.

Step Two:  Answer the questions.  Provide your bank account name and account number.  Do not include the routing number.  Complete an IRS W-9 form; its information must match the EIN or social security number that the BWC has for the business.

Step Three:  Have your signature on the claim form notarized.

Step Four:  If there are any differences between the business name in 2001-2008 and the current business name, explain in a cover letter.  Also explain if there are any differences between the business name and the bank account name.  Keep a copy of the claim form and the cover letter.

Step Five:  Mail the Sworn Proof of Claim form and W-9 to SAN ALLEN V BUREAU OF WORKERS’ COMPENSATION, C/O GCG, P O BOX 10107, DUBLIN OH 43017-3107.  If you want proof of delivery, have the documents delivered to:  SAN ALLEN V BUREAU OF WORKERS’ COMPENSATION, C/O GCG, 5151 BLAZER PKWY, DUBLIN OH 43017.

They will follow up with you if there are any discrepancies, and give you 20 days to “cure” them.

Actual payments may begin as soon as February 2015.

Posted in BWC, rebates.