Washington Application For Self-Insurance Certification is a form required by the Washington State Department of Labor & Industries (L&I) for employers who wish to become self-insured for workers’ compensation purposes. This form must be completed and submitted to the L&I Self-Insurance Unit for review and approval before an employer can become self-insured for workers’ compensation in Washington State. There are two types of Washington Application for Self-Insurance Certification: the first is for employers who wish to become self-insured for workers’ compensation, and the second is for employers who wish to become self-insured for industrial insurance. The application requires employers to provide basic information about themselves and their business, as well as information regarding any associated entities and the ability to provide financial security for the self-insurance program. Additionally, employers must provide information related to the risk management and safety programs they have in place, as well as any current claims experience.
Washington Application For Self-Insurance Certification
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General information. Contact the Washington State Department of Labor & Industries for information about agency programs and services in your language at 1-800-547-8367. Once you are on the phone, please hold a moment while we call an interpreter to help us.
You'll pay less in premiums every year. If you're self-insured, you're not paying an insurance company every year to carry the risk of replacing your income if something happens to you. That's a huge benefit to you because you're saving money!
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.
Someone who is self-insured is taking on the financial risks associated with insuring their vehicle. This means if there is an accident, they are responsible for paying for all the damage they caused to the other driver and their property, as well as any damage to their own vehicle.
Each state regulates who may be self-insured for workers' compensation. Normally, a prospective self-insured submits a required application accompanied by audited financial data, prior workers' compensation loss history, and other information required by each state.
A Certificate of self-insurance is issued to a non-University party as required by agreement and to evidence the required types of coverages are carried and covered by a self-insurance program.
Employers with self-insured employee health programs pay for medical claims and fees out of current revenue?in effect, acting as their own insurers. It's the alternative to a fully insured plan, where employers pay a fixed premium to a third-party commercial insurance carrier that covers the medical claims.