Washington Self-Insurance Certification Questionnaire

State:
Washington
Control #:
WA-SKU-3957
Format:
PDF
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Description

Self-Insurance Certification Questionnaire 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 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.

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Washington Self-Insurance Certification Questionnaire