R 408.43b Employer individual self-insurer; compliance with agency requirements; notice; additional time; certification; renewal application.

Rule 13b. (1) If the agency approves an initial application of an employer to be an individual self-insurer, then the approval must be in writing. The approval letter must contain the excess liability insurance terms, bond, letter of credit, and guaranties required by the agency as a condition of the self-insured authority. The employer has 30 days from the receipt of the agency’s notice in which to comply with the requirements of the agency. The self-insured authority may not become effective until the agency has received proof that all requirements of the agency for self- insured authority have been met. (2) The employer may, at the discretion of the agency, be granted additional time to meet the requirements for the self-insured authority. An employer shall make a request for an extension of time in writing within the 30-day compliance period. If the agency does not receive proof that all requirements for the self-insured authority have been met within the time prescribed, then the application is considered withdrawn. (3) The agency will issue a letter certifying self-insured authority to the employer when the employer meets the requirements of the agency. The self-insured authority for all approved employers expires on the designated renewal date, which may not be more than 12 months from the effective date of the authority. A self-insured employer shall submit a renewal application (form WC-402R), or its electronic equivalent, and requested documents, including a current financial statement and loss information, to the agency 30 days before the expiration of the self-insured authority. Upon receipt of a renewal application, the authority is extended until denied or approved for an additional 12 months.