become self-insured for workers compensation purposes in Oregon, an
employer must submit the following:
An application in a format prescribed by the director
(Available upon request: Jody
of the employers claims processing ability
Annual or audited financial statements for the last three fiscal years,
along with the SEC Form 10K (a 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
Evidence of ability to obtain a surety bond or an irrevocable standby
letter of credit
Security deposits are required to guarantee continued payment of claim liabilities
in the case of default. Adequacy of security deposits is reviewed annually
and may be required to be increased depending upon claim liability, financial
condition, and excess insurance coverage.
The Self-Insured Employer Adjustment Reserve and the Self-Insured Employer
Group Adjustment Reserve provide funds to pay claims in the event the self-insured
employer, or the self-insured employer group, fails or is unable to make
payments due under ORS Chapter 656.
Five or more employers may be approved to form a self-insured employer group
in accordance with ORS 656.430.
of self-insured employers
There are approximately 130 current active certified self-insured employer
plans in Oregon, which include approximately 1000 employers. There are currently
about 450 employers who are members of six self-insured employer groups.