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)