To apply for self-insurance an employer must complete the following forms.
In addition to the forms above, an applicant for self-insurance must submit:
- Five years of certified financial statements in accordance with Generally Accepted Accounting Principles (GAAP). This includes a balance sheet, a profit and loss statement, auditor’s opinion and all footnotes.
- A current organizational table showing all entities associated with the self-insurance applicant.
- The name, contact information and qualifications for the individual that will act as the Ohio workers’ compensation administrator.
- Organizational plan for the administration of the workers' compensation law.
- Proposed plan to inform employees of the change from a state-fund insurer and procedures employees must follow when filing for compensation and benefits.
- Secretary of State papers providing proof of registration to do business in Ohio.
- Information on your company’s risk- and claims-management procedures to establish a safe and more cost-effective workplace, including:
- Active senior management leadership.
- Employee involvement.
- Return-to-work practices.
- Communications affecting employee safety and health.
- Claims reporting practices.
- Coordination of safety and health practices.
- Written and communicated safe work practices.
- Written safety and health policy.
Additional information for public employers
A public employer must also respond to the following questions as part of the application process.
- What was the public employer’s bond rating as of the most recent fiscal year end?
- Has the public employer complied with all U.S. Securities and Exchange Commission (SEC) disclosures for the last five years?
- Has the public employer had any local government fund distributions withheld in the last five years?
- Has the public employer been placed on fiscal watch or emergency in the last five years?
- What were the unvoted debt capacities for the public employer for the two most recent fiscal years?
Applicants must submit completed applications and supporting documentation 90 days in advance of the desired effective date of self-insurance. Mail completed applications and supporting documentation to:
Ohio Bureau of Workers' Compensation
30 West Spring St., 22nd floor
Columbus, OH 43215-2256
Upon receipt of a complete application, BWC will underwrite all application documents and financial information. BWC will issue a written decision granting or denying self-insurance within 90 days. If the applicant disagrees with this decision, the applicant may submit an appeal within 14 days to the Self-Insured Review Panel.
If approved for self-insurance, BWC will schedule the employer for a self-insurance orientation session. This session will further explain the self-insurance process, procedures and administrative requirements.
Employers approved for self-insurance will also obtain information about the program requirements by viewing the Self-Insured Orientation tutorial. To access the tutorial, you must log in to the BWC Learning Center. If you’re a new user of the Learning Center, you must create an account.