Information for Current Members

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MEMBER INFORMATION UPDATE FORM

The Member Information Update Form can be accessed using the “LOGIN” button in the upper right corner of the screen, and is required of all members every year.  The annual MIUF requests information related to your workers’ compensation self-insurance, such as current member company and TPA contact information, employee data such as payroll, and claims data for the previous year.

The purpose of the Member Information Update Form is to maintain current contact information, and to collect loss data to accurately calculate your company’s security requirement. A copy of the MIUF is forwarded to the State Board of Workers’ Compensation each year.

FEES

Annual Assessment
After the initial year of self-insurance, assessments are computed at 1.5 percent of the total medical and indemnity paid the previous year. There is a maximum assessment of $8,000 and a minimum assessment of $2,000. Annual assessments are due 45 days from the date of the assessment invoice. If the assessment is not received by the Georgia Self-Insurers Guaranty Trust Fund within 45 days, the company will be penalized.

Penalties
Penalties are assessed at the direction and discretion of the Board of Trustees of the Georgia Self-Insurers Guaranty Trust Fund and can be assessed for multiple reasons:  late return of the annual Member Information Update Form, late return of corrections to the annual MIUF, late payment of the annual assessment fee, and/or late payment of any penalty fee. Generally, penalties are computed at $50 per day or 10% of the annual assessment, whichever is greater, and are due 20 days from the date of the penalty invoice.

Addition of Company to Self-Insurance Program

If you need to add a subsidiary or affiliate to your company’s self-insurance program, please submit a formal letter requesting the addition, along with the Request To Add Company form, which can be downloaded below.

The Request To Add Company form asks for information about the subsidiary/affiliate, including employee data from the most recent calendar year, as well as three years’ of medical and indemnity paid data.  If the subsidiary/affiliate is a new company with no loss history, please note that in your formal letter and answer the Request To Add Company form questions with N/A.

Please note that the State Board of Workers’ Compensation does not grant retroactive approval of subsidiaries/affiliates so please be sure your Request To Add Company form includes a future effective date.

The formal letter and Request To Add Company form should be e-mailed to gafund@deflaw.com.

DOWNLOAD FORM

Company Name Changes

If your company goes through a name change, please send a formal letter to gafund@deflaw.com notifying our office of the name change and the effective date of the name change. Upon receipt of this notification, our office will contact you with regard to changing your company’s name on security and excess.

If your company has an approved subsidiary or affiliate that undergoes a company name change, please send a formal letter to gafund@deflaw.com notifying our office of the name change and the effective date of the name change. A subsidiary/affiliate name change will not affect your security and excess.

EMAIL LETTER

SECURITY

All active self-insured employers must have security on file with the Georgia Self-Insurers Guaranty Trust Fund in the form of a surety bond or letter of credit, using the language approved by the Georgia Self-Insurers Guaranty Trust Fund. The required surety bond and letter of credit language can be found in the “SECURITY” section of this website and NO DEVIATIONS WILL BE ACCEPTED.

The amount of security required for your company is stated on an Order issued by the State Board of Workers’ Compensation. For information related to the calculation of security requirements, please see the “SECURITY” section of this website.

Canceled members are required to maintain security on file until they have been canceled for at least two (2) years, and have reported three (3) consecutive years of zero (0) open claims and $0 payments/reserves on the annual Member Information Update Form. For more information, please see the “SECURITY” section of this website.

Specific Excess Workers’ Compensation Insurance

All active members are required to have specific excess workers’ compensation insurance issued by an excess carrier with an A.M. Best Rating of “A-” or better.

Requests for SIR increases must be made in writing via a formal letter.  The formal letter requesting the SIR increase should be emailed to gafund@deflaw.com. The maximum SIR permitted is $750,000 per the Trustees’ 2013 Resolution.

Your excess policy and/or certificate of insurance must include the following requirements:

  • The member company insured by the policy, which must state the self-insured’s name followed by “and self-insured subsidiaries and affiliates, if any”
  • The insurance company that issued the policy
  • The effective date of the policy
  • The expiration date of the policy
  • The policy number
  • The self-insured specific retention amount of the policy followed by “per accident,” “per occurrence,” “each accident,” or “each occurrence”
  • The workers’ compensation limits of the policy, which must be “statutory”
  • A statement that the policy is a specific excess workers’ compensation policy
  • A list of states covered by the policy, which must include Georgia as a state of self-insurance operations
  • Occupational diseases (i.e.: asbestos) cannot be excluded from the policy
  • The bankruptcy and cancellation endorsements (please see the “Resources/Forms” section of this website for examples of the required endorsements)

Once your excess policy has renewed for the year, please send us a copy.  You can upload a copy of the excess policy/certificate of insurance by logging in to the MIUF portal of this website, or you can e-mail a copy to gafund@deflaw.com.

Audited Financial Statements

Pursuant to O.C.G.A. 34-9-388 (b), as a self-insured employer in Georgia, you are required to furnish a complete copy of your company’s audited financial statements to the Fund annually.  Members that have canceled self-insurance are expected to submit audited financial statements until the member company has been canceled for five (5) or more years.

These audited financial statements must include the following data:

  • Independent Auditors Report
  • Balance sheet – two (2) years’ worth of information
  • Income Statement
  • Statement of cash flows
  • Statement of stockholders’ equity and
  • Notes to the financial statements

You can submit the audited financial statements by logging into your dashboard and using the “upload a copy of your company’s most recent audited financial statements” link or by emailing a copy to gafund@deflaw.com.  Do not mail audited financial statements to our office.