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To become a certified self-insured employer or employer group for workers' compensation in Oregon, submit the following:

  • An application (See the forms page): 
  • Proof of the employer or employer group’s claims processing ability
  • Annual or audited financial statements for the past three fiscal years, along with the “SEC Form 10K” (Securities and Exchange Commission form), if issued
  • Evidence of an occupational safety and health loss-control program
  • Most recent experience rating modification worksheet
  • Types and retention levels of excess insurance
  • If applicable, a signed service agreement between the employer or employer group and all service companies (within limits)
  • A security deposit provided by either a surety bond company or an irrevocable standby letter of credit (unless an exempting city or county or public employer group with a loss reserve account)
  • Evidence of a common claims fund (self-insured groups)

Certification changes

Self-insured employers must inform the division in writing of any company changes or other information that may affect their self-insured certification. If they do not, they may be fined.

This information includes, but is not limited to:

  • Quarterly premium assessments (See current base rate bulletin)
  • Notification of changes in claims administration before change is made
  • Requests for approval to add subsidiaries as included entities 
  • Changes in company controlling ownership and  mergers
  • Changes in personnel that are responsible for your workers’ compensation program (names, titles, mailing address, email addresses, fax numbers, and telephone numbers)

​​​Help with workers’ compensation insurance
Workers’ Compensation Division
888-877-5670 (toll-free)

Business Identification Number

Employer coverage indexing

Small Business Ombudsman for Workers’ Compensation​​​​​​​

Active and Inactive Self-Insured Employers​​​​