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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​​​​

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