Washington Self-Insurance Certification Questionnaire is a set of questions designed to determine if an employer is eligible to self-insure its workers' compensation liabilities in Washington State. It is administered by the Washington State Department of Labor & Industries (L&I). There are four main types of Washington Self-Insurance Certification Questionnaires: Initial Application, Annual Renewal, Change of Status, and Change of Representation. The Initial Application questionnaire is used for employers who are seeking self-insurance status for the first time. The Annual Renewal questionnaire is used for employers who are renewing their self-insurance status. The Change of Status questionnaire is used when an employer’s self-insurance status has changed. The Change of Representation questionnaire is used when an employer’s representative has changed. The questionnaires ask employers to provide detailed information about their business, such as the type of business, number of employees, financial records, and insurance policies. They also ask questions about the employer’s safety program, workers' compensation claims experience, and financial responsibility. After completing the questionnaire, employers must submit it to L&I for review. L&I will then determine if the employer meets the requirements to become a self-insurer.
Washington Self-Insurance Certification Questionnaire
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FAQ
Online via our FileFast tool. By phone: 1-877-561-FILE (3453) At your doctor's office (if you complete the Report of Accident at your doctor's office, the doctor files the form for you)
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! And we're all about saving money where we can?especially on insurance premiums.
A qualified self-insurer is an organization that has satisfied state filing requirements, met the minimum financial and size criteria, and received approval to self-insure workers compensation or automobile liability.
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.
Advantages And Disadvantages Difficult to develop a self-insured plan as the initial costs involved might be complex. There are no policy limits, as the insurance is customized per the applicant's needs. High chances of risk because some claims might be overly costly.
Being self-insured means that rather than paying an insurance company to pay medical, dental and vision claims, we pay the claims ourselves, using a third-party administrator to process the claims on our behalf.
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.