Should my business self-insure?
To help you decide whether or not to apply to self-insure, please see the How Do I Apply? tab. This will help to create a cost comparison between self-insuring or insuring through L&I.
Things to consider:
- Ask your L&I account manager for your company’s 3-5 year claim history. Review both the number of claims and the related claim costs. This will help you forecast your required self-insured assessments that are based on claims costs.
- Review the worker hour information from your Quarterly Report. This will help you forecast your required self-insured assessments that are based on worker hours.
- Review current and past self-insurance assessment rates.
- Third Party Administrator (TPA) costs.
- The Employers' Guide to Self-Insurance in Washington State (F207-079-000) [pending update] provides additional details about employer requirements and responsibilities.
How do I apply to be self-insured?
To apply to be self-insured, an employer must complete and submit the following documents:
- Application for Self-Insurance Certification (F207-001-000) with a nonrefundable fee.
- Self-Insurance Certification Questionnaire (F207-176-000).
- Three years of audited financial statements in the name of the applicant.
- List of physical locations and addresses in Washington including subsidiary operations.
- Copy of your written Accident Prevention Program (APP). If multiple locations, more than one copy may be required.
- Self-Insurance Electronic Data Reporting System (SIEDRS) enrollment form (F207-193-000).
Additional forms that may be required:
Review various forms noted in WAC 296-15-021 and WAC 296-15-121
Surety, a legal financial guarantee, must be secured by:
Self-Insurer’s Bond (F-207-068-000)
Escrow Agreement (F207-039-000) (request L&I designated banks)
Irrevocable Stand by Letter of Credit (F207-112-000) (only firms with a net worth in excess of $500 million)
Self-Insured Employer Certification of Excess Insurance (F207-095-000) (optional insurance coverage)
Completed application packets can be sent electronically to certificationsvcs@Lni.wa.gov.
Audited financial statements may be sent separately through postal services:
Department of Labor & Industries
PO Box 44891
Olympia, WA 98504
Department of Labor & Industries
7273 Linderson Way SW
Tumwater, WA 98501
How do I maintain my self-insured status?
Once you are approved for certification as a self-insured employer, there are requirements that need to be met in to maintain that certification. Those requirements are:
- File Self-Insurance Quarterly Reports.
- Pay assessments.
- Submit audited annual financial statements 6 months after the close of the company’s financial year end.
- Submit the Annual Report of Self-Insured Business by March 1 of every year.
- Submit monthly claim data to L&I via Self-Insurance Electronic Data Reporting System (SIEDRS).
- Report payment of medical bills via the medical bill electronic data interchange (EDI).
- Maintain the required surety.
- Employers must retain a licensed TPA, or if self-administered, employ certified claim administrators in accordance with RCW 51.14.170.
- Notify us of business status changes.
Refer to self-insurer’s reporting requirements in WAC 296-15-221.