Sec. 14.09.13.02. Application

A. Requirements.

(1) An initial application for individual self-insurance shall be submitted to the Commission on forms prescribed by the Commission and shall include all required information and documentation required by the Commission.

(2) A nonrefundable fee in the amount established by the Commission shall accompany the application.

(3) The required information on the application shall be fully completed and particularly set forth under oath by the employer or an individual acting on the employer's behalf. The affidavit shall be made upon personal knowledge of the matters set forth in the application. The Commission may require the applicant to supplement or explain any of the matters set forth or to provide additional information that the Commission considers necessary.

(4) Upon receipt of a complete application and all required information and documentation, the Commission shall act upon the application for self-insurance within 60 days.

B. Parental Guarantees and Subsidiaries.

(1) When an employer applying to self-insure is a subsidiary company, the parent company shall provide, on forms prescribed by the Commission, a written agreement adopted by its board of directors which states that the parent company guarantees the payment of all claims incurred by the self-insurer and its affiliates and subsidiaries that are approved under the self-insurance program. The parent company shall further assume liability for the payment of an affiliate's or subsidiary's claims incurred during its period of self-insurance upon termination of the affiliate or parent-subsidiary relationship until formally released by the Commission.

(2) When a subsidiary company applies to self-insure under a parent company's existing self-insurance program, the subsidiary company shall file an application on forms prescribed by the Commission.

C. Approval.

(1) In determining whether an applicant is eligible for self-insurance and in establishing the amount of surety required, the Commission shall consider all relevant factors including the following:

(a) Established record of financial stability and solvency, including:

(i) Net worth or unrestricted net assets of not less than $10,000,000 and at least 20 times average annual incurred claims net of reimbursements for the past 3 years;

(ii) Profitable and positive cash flow from operations 3 out of the last 5 years;

(iii) Acceptable debt-equity ratio;

(iv) Acceptable current and quick ratio;

(v) Acceptable interest coverage ratio; and

(vi) Acceptable financial stability of surety, excess carrier, or letter of credit issuer;

(b) The proposed excess insurance policy limits and retention level;

(c) The experience of the organizational unit or service company processing and handling claims in the State;

(d) Workers' compensation loss history of the applicant;

(e) The number of years in business, with a minimum of 3 consecutive years before application; and

(f) Number of employees.

(2) Not-for-profit organizations need not be profitable if all other provisions are satisfied and there are significant investments or endowments and other resources to assure payment of workers' compensation claims.