8 AAC 46.080. Application for renewal

(a) A self-insurer shall submit an application for renewal to the board on Department of Labor form number 07-6130. The completed application must be

(1) filed at least 60 days before the expiration of the certificate of self-insurance;

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

(3) accompanied by the self-insurer's audited financial statements, not previously submitted to the board in support of a prior certificate of self-insurance, for the fiscal or calendar year immediately preceding the year in which the self-insurer applies for renewal; a public entity must submit its audited comprehensive annual financial reports and detailed schedules, not previously submitted to the board in support of a prior certificate of self-insurance, for the fiscal or calendar year immediately preceding the year in which the public entity applies for renewal; and

(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 either a guarantee of coverage until receipt by the board of a copy of the policies or a renewal endorsement specifying the renewal terms of the policies is submitted to the board by the effective date of the renewal certificate.

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

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

Authority: AS 23.30.005

AS 23.30.075

AS 23.30.090

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