In order to maintain your workers compensation self-insurance status you will need to meet these reporting requirements:

• Filing Quarterly Reports for Self-Insured Business (F207‑006‑000).
  • As a self-insured employer, you must report claim costs and worker hours quarterly to L&I.
  • Pay quarterly assessments based on claim costs and worker hours when submitting quarterly report.
• There are 2 reports you must submit annually to L&I:
  • An audited financial statement prepared by an independent certified auditor within 6 months of a company's financial year end.
  • Annual Report of Self-Insured Business (SIF‑7) (F207‑007‑000) showing the amounts of claim payments and reserves by March 1. This data is used by L&I to determine the surety requirement annually.
• Use SIEDRS to submit claims data monthly to L&I.
• See WAC 296‑15‑221 (www.leg.wa.gov) for additional reporting requirements.

Certification forms:

• Self-Insurer's Bond - Existing Liabilities (F207‑068‑000).
• Special Escrow Agreement (F207‑039‑000).
• 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).

Read the Employers' Guide to Self-Insurance in Washington State (F207‑079‑000) to better understand employer requirements and responsibilities.