All self-insured employers must be approved by the Department.
Please see Rule 25 [PDF] for information.
- Approved Self-Insured Employers
- Form 30 – Application for Self Insurance [PDF]
- Bond Form for Self-Insured Employers [PDF]
- Assumption and Guarantee Form [PDF]
- Self-Insurer’s Report [PDF]
For information contact J. Stephen Monahan at firstname.lastname@example.org