The Information that You Will Need To Provide to Self-Insure WCA
State Self-Insurance Permits - Third Party Administratrors - Excess Insurers - Bond Underwriters
This is a general list of the information that you will most likely need to supply to your State as well as to your Third Party Administrator, Excess and Bond Insurers.
1. The State self-insurance permit
To obtain a State self-insurance permit you will need to provide the following:
- A history and overview of your organisation.
- Details of ownership
- Your Workers Compensation claims activity for the last three years.
- Details of your safety or loss control program.
- Who will be administering your claims and providing your excess insurance.
- Audited Financial Data for the last three years.
2. The Third Party Administrator
A Third Party Administrator will require the following information:
- Details of your past loss experience showing both the frequency and severity.
- Background information on your company including where your locations are and how many employees you have.
- How your loss control program will operate.
- Your reporting requirements for claims.
3. The Excess Insurer
Excess Insurers will require the following information:
- A history and overview of your organisation.
- Past 5 Years payroll information
- Past 5 Years workers compensation claims data. Loss reports should be available from your current insurer.
- Detail of any individual claims that have exceeded $25,000
- Budgeted payroll by class for the coming year
- Details of your safety or loss control program.
- Who will be administering your claims and providing your excess insurance.
- Details of usage of any owned or chartered aircraft or watercraft.
- Audited Financial Data for the last three years.
4. The Bond Underwriter
Bond Underwriters will require the following information:
- A history and overview of your organisation.
- Details of any subsidiary companies.
- Audited Financial Data for the last three years.
