Information for Applicants
APPLICATION PROCESS
The application for self-insurance can be downloaded below. Original, completed applications should be sent in duplicate to the State Board of Workers’ Compensation, along with three separate years of audited financial statements and the application fee of $500. The check for the application fee must be made payable to the Georgia Self-Insurers Guaranty Trust Fund.
After the application is reviewed by the State Board of Workers’ Compensation, one original version of the application, the financial statements, and the application fee are sent to the Georgia Self-Insurers Guaranty Trust Fund. The Trustees of the Georgia Self-Insurers Guaranty Trust Fund will review the application and financial statements, and make a recommendation to the State Board of Workers’ Compensation regarding the acceptance of the applicant for self-insurance.
The State Board of Workers’ Compensation has final authority regarding the acceptance of any applicant, and will issue an Order accepting or rejecting the applicant. The State Board of Workers’ Compensation’s Order will state the provisions under which the applicant has been accepted, including the amount of security to be filed with the Georgia Self-Insurers Guaranty Trust Fund, the requirements for specific excess workers’ compensation insurance, and payment of the initial assessment fee of $8,000.
Applicants approved for self-insurance are required to annually submit audited financial statements, the Member Information Update Form, assessment fees, and specific excess workers’ compensation insurance. Self-insured members must also provide and maintain security in the form of a letter of credit or surety bond.
FEES
Application Fee
The application fee for all applicants is $500. The fee should be submitted with the application for self-insurance and can be made via ACH or by writing a check payable to the Georgia Self-Insurers Guaranty Trust Fund.
Initial Assessment
The initial assessment for all applicants is $8,000. This assessment fee is due to the Georgia Self-Insurers Guaranty Trust Fund at the time the employer’s self-insurance commences.
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.