Alabama Employers Application For Self Insurance

State:
Alabama
Control #:
AL-018-WC
Format:
PDF
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Description

Employers Application For Self Insurance

Alabama Employers Application For Self Insurance is a form that employers in Alabama must fill out if they wish to provide their own workers' compensation insurance. This form is used to inform the State of Alabama of the employer's intent to provide self-insurance and to provide information on the employer's financial capacity to pay claims. The application must be approved by the State before the employer can provide its own insurance. There are two types of Alabama Employers Application For Self Insurance: the Group Self-Insurance Application and the Single Employer Self-Insurance Application. The Group Self-Insurance Application is for employers who wish to self-insure as a group, and the Single Employer Self-Insurance Application is for those who wish to self-insure as an individual employer.

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(Submit one completed copy). CONFIDENTIAL. The application is to be completed in full and accompanied by: (1).Self-insurer's latest audited annual financial report;. Self-Insurance employers provide workers' comp insurance benefits directly to the injured worker. Insolvent Self-Insurers. Do the preceding companies have a working knowledge of the Utah Workers' Compensation Act and Rules? Yes No. (Please include curriculum vitae). Self Insurance Bond. Self-Insurance Division, in conjunction with the Employer's Initial Application for Self-Insurance. (Please print or type all information.

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Alabama Employers Application For Self Insurance