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Supplemental Application - Subsidiary Coverage. Page 1 of 3. Self-Insured.Employers wanting to self-insure their workers' compensation liabilities must apply to the Office of Self-Insurance Plans (OSIP) for approval. 1) Completed Form LS-271, Application for Self-Insurance. A separate application must be completed under each Act for each separately incorporated subsidiary. WORKERS' COMPENSATION SELF-INSURANCE APPLICATION. The following examples and information are provided to help employers complete the self-insurance renewal application. The application is to be completed in full and accompanied by: (1). Self-insurer's latest audited annual financial report;. If a company is granted self insurance status, they will be mailed a self insurance application to complete.