Information required for Self-Insuring Workers’ Compensation
This is a general list of the information that a company will most likely need to provide to its State as well as to the Third Party Administrator, Excess and Bond Insurers. Please note that the required information will vary according to different States or the service provider being used.
The Information Required for a Self-Insurance Permit
- A history and overview of your organisation
- Details of company ownership
- Details of your safety or loss control program
- Who will be administering your claims and providing your excess insurance
- Your Workers Compensation claims activity for the last five years
- Audited Financial Data for the last three years
The Information Required for a Third Party Administrator
- Details of your past workers’ compensation loss experience showing both the numbers of claims and cost of each claim
- Background information on your company including where your locations are and how many employees you have
- How your loss control program will operate
- The proposed reporting requirements for claims
The Information Required for an Excess Insurer
- A history and overview of your organisation
- Past 5 Years payroll information
- Past 5 Years workers’ compensation premium and claims data
- Details of any individual claims that have exceeded $50,000
- Budgeted payroll by class for the coming year
- Details of your safety or loss control program
- Who will be administering your claims and providing your excess insurance
- Details of usage of any owned or leased chartered aircraft or watercraft
- Audited Financial Data for the last three years
The Information Required for a Bond Underwriter (if preferred to a Letter of Credit)
- A history and overview of your organisation
- Audited Financial Data for the last three years
- A reference from your bank
Also in this section
A History of Workers' Compensation
Reasons to Consider Self-insuring Workers' Compensation
Initial Considerations For Self-Insuring Workers' Compensation
Self- Insuring Workers Compensation - The Four Step Process
How Workers Compensation Excess Insurance works
Selecting an Excess Insurer for Workers Compensation
