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) 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
Self-Insurance Section
PO Box 44891
Olympia, WA 98504

or

Department of Labor & Industries
Self-Insurance Section
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.