An employer who wishes to self-insure for workers’ compensation can apply for the privilege to self-insure in New York. Political subdivisions must also provide workers’ compensation coverage to their employees, and they may elect to self-insure those benefits.
An employer who wishes to self-insure on an individual basis for workers’ compensation benefit must meet the following criteria to apply:
- Three years in business in a legally authorized business form (e.g., corporation, partnership, proprietorship, non-profit);
- Proof of current worker’ compensation coverage;
- No outstanding procedural or compliance penalties;
- A Moody’ rating of A3, S&P rating of A- or greater at time of application. If a published rating is not available, an equivalent rating using credit risk assessment tools such as Moody’ RiskCalc may be used;
- Tangible net worth must exceed seven times the greater of three-year average gross claims payments or annual premium paid;
- Three years of certified, independently audited financial statements with auditor’ opinion absent of negative qualifications; and
- Safety program maintained by the employer for the prevention of accidents.
To apply, submit the following electronically:
- Application for Self-Insurance (Form SI-1) - Workers’ Compensation Law for each entity applying, regardless of affiliation;
- All documents noted above proving eligibility.
If the Office of Self-Insurance notifies an applicant that conditional approval is granted, the applicant must submit the following:
- Signed and notarized Agreement and Undertaking of Employer to Pay Compensation (Form SI-3) as a self-insured;
- Certificate of Excess Insurance Contract for Self-Insurers (Form SI-21);
- Security deposit in a form prescribed by the Chair; and
- Other documentation as necessary.
The initial amount of the security deposit will be based upon the information provided in the application, as well as rates developed by the Compensation Insurance Rating Board (CIRB).
The minimum security deposit effective July 1, 2023 is $1,787,000.
The Office of Self-Insurance will notify an applicant of final approval if all conditions are met. Every year that the employer remains self-insured, the security deposit is reviewed for adequacy, based upon information provided in the self-insurer’s annual reports and current rates. Employers must adjust their security deposit to adequate levels as determined by the Board.
Surety Bond with Electronic Signatures
The New York State Electronic Signatures and Records Act (ESRA) gives electronic signatures and electronic records used or accepted in New York State the same legal validity and effect as hand-written signatures and paper-based records, subject to certain exceptions stipulated in ESRA. In accordance with ESRA, an electronic signature is an electronic sound, symbol, or process, attached to or logically associated with an electronic record and executed or adopted by a person with the intent to sign the record. An electronic signature is "attached to or logically associated with an electronic record" if the electronic signature is linked to the record during transmission and storage.
Surety Bonds with electronic signatures that comply with the provisions of ESRA, are acceptable to the Board and legally binding. The Board has determined that the following surety bond and rider forms will be accepted with electronic signature:
- SI-8 (Self-Insurer's Surety Bond);
- SI-8.1 (Surety Bond Rider); and
- SI-8A (Self-Insurer's Surety Bond - Additional Affirmations).
Such forms must: (1) be complete and correct, with no alterations to language or content; (2) must be executed using a certificate-based signature, using Adobe Acrobat or Adobe Reader; and (3) be properly acknowledged by a Notary Public, in accordance with NYS requirements for Electronic Notarization which require that the Notary Public be physically present in the State of New York.
To sign a document with a certificate-based signature, an individual must obtain a digital ID or create a self-signed digital ID in Adobe Acrobat or Adobe Reader. Additional instructions for executing a document electronically, using Adobe Acrobat or Adobe Reader to create a certificate-based signature can be found on Adobe's Certificate-based signatures page.
More information regarding electronic signature can be found in the Electronic Signatures and Records Act (ESRA) document, located on the New York State ITS website.
Please note that while the Board is accepting surety bond forms with electronic signature, use of electronic signatures is not required. Printed Bonds with wet ink signatures will still be accepted.
Annual Reporting Requirements
While actively self-insured, each employer must submit the following annually:
- Certified, independently audited financial statements 90 days after fiscal year end;
- Self-Insurers Report of Payroll for All Operations (Form SI-6) due by April 1st;
- Actuarial report due by April 1st, prepared in accordance with guidance promulgated by the Board; and
- Certificate of Excess Insurance Contract for Self-Insurer (Form SI-21) prior to the expiration of the current policy.
Failure to meet any of the reporting or security deposit requirements may result in termination of the employer’ status as a self-insurer.
Chapter 57 of the Laws of 2013 authorized the Workers' Compensation Board (Board) to streamline the manner in which it collects its administrative and special fund assessments and implement a process that will be consistent among the various categories of payers and based upon active coverage. The Board expects the assessment process will offer all payers a more equitable, predictable and efficient manner to manage their share of Board assessment expenses.
Pursuant to WCL §151, the Chair shall annually establish an assessment rate to be effective January 1 of the subsequent calendar year. In accordance with Title 12 NYCRR Part 318 that governs the assessment process, the assessment rate will be determined by dividing the total estimated annual expenses by a base of total estimated statewide premium. All payers will be required to apply the assessment rate to their premium or premium equivalent and submit payment quarterly.
Information is available on the rules and regulations that govern the assessment process, prescribed forms, frequently asked questions, as well as other information related to assessments.
Questions may be sent to: WCBFinanceOffice@wcb.ny.gov
- Annual Assessment Base Factor Form (Form GA-1.6)
- Private Self-Insurers Remittance Form (Form GA-3)
- Annual Private Self-Insured Assessment (Form GA-5 50-5)
A self-insurer who has discontinued business in New York State, or has arranged for the payment of compensation by alternate methods (NYSIF or insurance carrier coverage), may terminate their status as a self-insurer at any time by notifying the Office of Self-Insurance. The Board will maintain a security deposit for the inactive self-insured employer until all claims have been finally adjudicated and fully paid, all expenses and assessments have been paid, and until such time as the Board determines there is no future liability.