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Texas Workers Compensation Self-Insurance Group (SIG) Employer Membership Form

State:
Texas
Control #:
TX-FIN467-WC
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PDF
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Workers Compensation Self-Insurance Group (SIG) Employer Membership Form

Texas Workers Compensation Self-Insurance Group (SIG) Employer Membership Form is a document that employers must fill out in order to become a member of the Texas Workers Compensation Self-Insurance Group. This form requires employers to provide information related to their business, such as company name, address, contact information, and financial information. The employer must also provide details of any prior workers’ compensation insurance coverage, the number of employees, and the type of work their employees perform. Upon completion of the form, the employer must submit the form, along with the appropriate fee, to the Texas Workers Compensation Self-Insurance Group. There are two types of Texas Workers Compensation Self-Insurance Group (SIG) Employer Membership Forms. The first type is for employers who are first-time members of the Texas Workers Compensation Self-Insurance Group. The second type is for employers who are renewing their membership with the Texas Workers Compensation Self-Insurance Group.

How to fill out Texas Workers Compensation Self-Insurance Group (SIG) Employer Membership Form?

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FAQ

What Is Self-Insurance? Self-insurance involves setting aside your own money to pay for a possible loss instead of purchasing insurance and expecting an insurance company to reimburse you.

Call 800-252-7031, option 1. Workers' compensation is an insurance program managed by the State of Texas.

In order to opt out of workers' compensation, an employer has to take these four steps: File DWC Form-005 with the Texas Division of Workers' Compensation annually stating that the employer is a non-subscriber. Notify employees in writing at the time of their hire that the employer is a non-subscriber.

What if I don't provide workers' compensation? If you don't provide workers' compensation coverage, you lose the legal protection against most lawsuits. This means an injured employee can sue you over a workplace injury or illness.

However, there are exclusions to this rule for some employers listed below: Any public employer including cities, counties, state agencies and state universities. Building and construction contractors for public employers. Motor bus companies and motor carriers.

If you can't determine whether an employer has coverage, email coverage.verification@tdi.texas.gov and include: Name of the employer. Physical address of the employer.

In Texas, private employers can choose to carry workers' compensation insurance coverage, but it is not required in most cases. A workers' compensation insurance policy provides lost wages and medical benefits to employees injured on the job.

More info

Workers' Compensation Self-Insurance Group (SIG). Opportunities for membership in an existing SIG are further limited to the homogeneity requirements of the current Self-Insured Groups.Other Workers' Compensation Self-Insured Group (SIG) Certificate of Approval Forms. This document is a synopsis of the requirements to become authorized to self-insure workers' compensation liabilities in Minnesota. Application for workers' disability compensation self-insured authority is made on Form WC-402. Questions 1through 10 must be completed. Application for group self-insured authority is made on form WC-402G. SELF-INSURANCE GROUP. Address. Telephone. Number. Gov or call (602) 542-1836. How Does a SIG work.

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Texas Workers Compensation Self-Insurance Group (SIG) Employer Membership Form