SELF-INSURANCE: WHAT IS NEEDED?
Listed below is the information most likely to be requested by your state, the firm doing your feasibility study, prospective claims administrators, excess workers' compensation underwriters and bond underwriters asked to provide quotations.
While you may be asked to complete a specific application or form, the information requested will typically be the same as we've listed below.
For the Feasibility Study

Workers' compensation claims data for the most recent five to ten years.

Payroll data for the most recent five to ten years.

Workers' compensation premiums for the most recent five to ten years.

For the State Self-Insurance Permit

Audited financial data for the past several years.

A general history of your firm or organization.

Information relative to the ownership of your firm.

Workers' compensation claims data for the most recent three to five years.

Information about your loss control program.

The names of your probable claims administrator and excess workers' compensation insurer.

For The Claims Administrator / Service Company

Copies of actual workers' compensation claim printouts (called "loss runs") showing both the dollar amount of the claims and the number of claims.

General information about your organization, including number of locations and employees, and size of payrolls.

Information regarding your expectations for a loss control program and your desires for frequency of claims reports.

Your desired involvement in the claims process, such as regular meetings to review large claims, etc.

For An Excess Workers' Compensation Underwriter

Seven to ten years prior workers' compensation and losses and premium, including your workers' compensation experience modification worksheets, if available. The insurance broker or TPA working with the excess underwriter(s) can help you prepare this information.

Seven to ten years prior payroll data (insurance company audits are best) and have budgeted payrolls for the coming year.

Details on any workers' compensation claim larger than $100,000.

General information on your firm, its history, etc.

Information on the use of any watercraft or any owned, leased, or chartered aircraft.

The name(s) of prospective claims service companies.

For The Bond Underwriter

Three years audited financial statements, plus interim financial statements for the current year.

Banking references.

General background of your organization.

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