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Request for an Elimination of Security

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To be considered for an elimination of security, a member must meet the following criteria:

1. Cancelled for at least two (2) full years.
2. All self-insured claims must be closed by the State Board of Workers' Compensation for a period of two (2) years following the cancellation date.
3. The employer cannot have made any payments during the last twelve (12) months and the employer must confirm that they have not received any unpaid medical invoice(s) over this same period.
4. Confirmation that no indemnity has been paid in the last three (3) years.
5. Confirm the amount of medical paid over the last three (3) years.
6. Has four (4) years lapsed since the last indemnity payment related to GA Code Section 34-9-261 or 34-9-262?

If these requirements have been met, a member may submit a formal letter on their company's letterhead requesting an elimination of security and provide any supporting documentation. The Fund will request a Member Certification, as well as a TPA Certification advising of the number of open claims and reserves. Also, you will be asked to provide a copy of your company's loss run to include all open claims and the last two (2) years of closed claims that occurred during the member's self-insurance period. The loss run must include the following data:

1. Name of Claimant
2. Date of Injury
3. Last 4 Digits of Claimant's Social Security Number
4. Description of Injury
5. Medical Paid to Date
6. Indemnity Paid to Date
7. Unpaid Medical Reserves
8. Unpaid Indemnity Reserves

The member's request will then be placed on the next Board of Trustees meeting and the Trustees will make a recommendation that will be submitted to the State Board of Workers' Compensation. If the State Board agrees with the Trustees' recommendation, an order will be issued.

Forms

Self Administered Certification

TPA Certification

Member Certification