In order to maintain your certification as a self-insured employer, you need to regularly report information to L&I. Please note that these reporting requirements are separate from the financial qualifications.
Every quarter you must report claim costs and worker hours.
This information helps L&I accurately calculate self-insurance assessments.
Prefilled Quarterly Report forms are distributed electronically to self-insured employers.
Completed forms can be returned by email to: CertificationSvcs@Lni.wa.gov.
Payments are mailed separately to:
Department of Labor & Industries
Self-Insurance Certification Services
PO Box 24442
Seattle, WA 98124-0442
Quarterly Billings and Reports training materials are available for review. If you have questions about how to complete forms, contact us.
There are two annual reports a self-insured employer must submit to L&I.
Audited Financial Statements:
This must be prepared by an independent certified auditor and submitted to L&I within 6 months of a company's financial year end.
Annual Report of Self-Insured Business (SIF-7) (F207-007-000):
Prefilled Annual Report forms are distributed electronically to self-insured employers in January of each year.
Completed forms are due back March 1st and can be returned by email to: CertificationSvcs@Lni.wa.gov.
Payments are mailed separately to:
Department of Labor & Industries
Self-Insurance Certification Services
PO Box 44891
Olympia, WA 98504
If you have questions about how to complete these forms, contact us.
Self-Insurance recommends the following COVID-19 claim coding for SIEDRS:
- 199-Other Miscellaneous Causes
- 273-Contagious Disease
- 360-Lungs
The Self-Insurance Electronic Data Reporting System (SIEDRS) is a computer system that electronically collects claim information from self-insured employers. All self-insurers must send this claim data to L&I at least once a month.
To enroll and use SIEDRS, L&I must receive a completed SIEDRS Enrollment Form (F207-193-000).
The SIEDRS Enrollment Package (F207-194-000) explains how to prepare your computer systems so that the data can be communicated to L&I.
To correct errors, use the SIEDRS (Self-Insurance Electronic Data Reporting System) Data Change Request (F207-197-000).
Claim data can help L&I understand the performance of the self-insured community, which helps inform and guide policy.
L&I produces quarterly SIEDRS reports so that self-insurers have visibility to data.
Self-insured employers are required to report the payments of medical bills that relate to their firm’s industrial insurance claims. This medical bill data supports policy conversations and guides industry decisions that help injured workers heal and return to work. It also helps to set industry benchmarks.
The medical bill data is submitted to L&I through an electronic data interchange (EDI).
Please register to report medical bill EDI data.