What are the procedures to apply for workers compensation self-insurance?
Call (801) 530-6841 for a self-insurance packet, or write to Self Insurance Coordinator, Utah Labor Commission, Division of Industrial Accidents, P. O. Box 146610, Salt lake City, Utah 84114-6610. The packet includes an application, forms, self-insurance rules and a letter explaining what is required to submit which includes: $1200.00 application fee (Nonrefundable) Fully completed application Most recent certified financial statement Dun & Bradstreet rating Profit and loss history Organizational structure and management background Compensation loss history Source and reliability of financial information Proposed excess insurance coverage Guarantee by parent company Proposed surety bond Claims administration Bankruptcy and Insolvency Endorsement An annual assessment is imposed on workers’ compensation insurance premiums. For self-insured employers, the assessment for workers’ compensation purposes is based upon an amount equivalent to premiums, which would be paid by the employer as if
