Temporary Authorization To Review Information {BWC-0503}

BWC-0503 - TEMPORARY AUTHORIZATION. This form is from the Bureau of Workers' Compensation and used to authorize a third party, such as a representative or a third-party administrator (TPA), to review and perform studies on certain workers' compensation matters on behalf of an employer. The form specifies the types of information the authorized party can access, such as risk files, claim files, and other associated data. It also outlines limitations to the authorization, such as restrictions on reviewing protest letters or representing the employer at hearings. Completion of the temporary authorization provides a third-party administrator (TPA) limited authority to view an employer's payroll and loss experience. By signing the AC-3, the employer grants permission to the BWC to release information to the employer's authorized representative(s). The form allows a TPA to view an employer's information regarding payroll, claims and experience modification. www.FormsWorkflow.com