Along with reviewing the Self-Insurance Certification Questionnaire (F207‑176‑000), we recommend you do the following analysis:
- Check out these required forms:
- Application for Self-Insurance Certification (F207‑001‑000).
- Self-Insurer's Bond - Existing Liabilities (F207‑068‑000).
- Escrow Designated Banks (F207‑039‑000). L&I has designated these banks as depositories (42 KB PDF).
- Irrevocable Stand By Letter of Credit (F207‑112‑000).
- Only firms with a net worth in excess of $500 million.
- Self-Insured Employer Certificate of Excess Insurance (F207‑095‑000) (optional).
- Look at what L&I self-insurance charges for assessment rates
- Current Assessment Rates.
- Past Assessment Rates (past 3 years).
- Ask for your claims history from your L&I account manager (listed on your quarterly report).
- Pick time frame for evaluation (3 to 5 years recommended).
- Look at the number of claims and your claim costs. This will help you forecast the self-insured assessments that are based on claims costs.
- Review the worker hour information from your quarterly report. This will help you forecast the self-insured assessments that are based on worker hours.
- Third Party Administrator (TPA) costs.
- Cost of surety.
- Check out these resources to:
- Learn more about the Accident Prevention Program (APP) requirements.
- Get help developing an APP from the Safety and Health Consultation staff.
Read the Employers' Guide to Self-Insurance in Washington State (F207‑079‑000) to better understand employer requirements and responsibilities.
