This unit grants the authority for private companies or groups of companies to self-insure their workers' compensation obligations in the State of Minnesota, subject to the requirements in Minn.. Stat. ß79A .01 - .18. The process includes, but is not limited to, review of the application, financial position, actuarial study and loss history of the applicant(s) to assure that they are in compliance with the law.
Application package - Contains all of the documents needed to apply for licensure as a Workers Compensation Self Insurer. It includes a checklist, instructions for completing the application, the application itself and other forms needed to become licensed.
Requirements (.pdf) - Contains an outline including the financial, actuarial, reinsurance and security deposit requirements necessary to become self insured for Workers Compensation.
The Status Report is required each year for all active Workers' Compensation Self-Insurers licensed under Minnesota Statutes 79A.01-.18. The required $500.00 annual fee should be attached to the status report.
This Custodial Agreement is needed for Workers' Compensation Self-Insurers who post security as part of their authority. It is used by both Active Individual and Group Workers' Compensation Self-Insurers.