8 AAC 46.020. Application for self-insurance certificate

(a) An employer shall apply for a self-insurance certificate on Department of Labor and Workforce Development form number 07-6129. The completed application must be

(1) filed with the board at least 90 days before the desired effective date of self-insurance;

(2) signed before a person authorized to take an oath, affirmation, or acknowledgement;

(3) accompanied by the employer's audited financial statements for the three fiscal or calendar years immediately preceding the filing of the application; the employer may submit consolidated financial statements of its parent company if the employer does not have its own audited financial statements and the employer is a majority or wholly-owned subsidiary; a public entity must submit audited comprehensive annual financial reports, including detailed schedules, for the three fiscal or calendar years immediately preceding the filing of the application;

(4) accompanied by a description of the proposed excess insurance including the effective dates, the types of coverage, the conditions and exclusions, the limits and retentions of each type of coverage, and a guarantee of coverage until the board receives a copy of the policies; and

(5) accompanied by a parent company's guarantee of the subsidiary's obligations under the Act, if the employer is a majority or wholly-owned subsidiary.

(b) If the employer or its parent company self-insures its workers' compensation obligations in any other jurisdiction, the application must be accompanied by a summary of the most recent filings, including a summary of losses, self-insured retention limits, and other data pertinent to the other self-insurance programs. The summary of losses must be categorized by total incurred loss, amount of loss within retention limit, amount of loss subject to reinsurance or excess recovery, and amount of loss subject to subrogation recovery.

(c) An employer shall submit, as part of the application, a detailed outline or manual of its safety/loss control program.

(d) An employer shall report for the most recent three years, its total Alaska payroll, Alaska workers' compensation losses, and premiums paid.

History: Eff. 11/20/83, Register 88; am 7/20/97, Register 143; am 7/2/98, Register 146

Authority: AS 23.30.005

AS 23.30.075

AS 23.30.090

Editor's note: As of Register 151 (October 1999), the regulations attorney made technical revisions under AS 44.62.125 (b)(6) to reflect the name change of the Department of Labor to the Department of Labor and Workforce Development made by ch. 58, SLA 1999 and the corresponding title change of the commissioner of labor.

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