Rule 72: Self-Insurance — Requirements for Approval

A. The following factors will be among those used in analyzing an application and determining whether an employer can be granted approval to self-insure:

1. standard financial ratio analysis and comparison to similar industry statistical data;

2. historical operating results;

3. evaluation of financial trends;

4. organizational structure and management background;

5. contingent liabilities;

6. pending litigation;

7. general and specific industry economic conditions;

8. number of employees;

9. current and historical loss experience, reserves, and modification factor;

10. safety program;

11. nature of business;

12. claim administration procedures, and;

13. proposed retention and limits for excess insurance.

14. claims record regarding delinquent payment of indemnity and medical expenses, as defined by section 48-125.

B. The court will approve employers to self-insure who meet the requirements of Rule 71,A and can provide:

1. satisfactory proof of financial strength and liquidity to meet all obligations under the Nebraska Workers’ Compensation Act;

2. a fully executed parental guarantee if the employer is a subsidiary;

3. acceptable arrangements for claim administration and injury and payment reporting;

4. security in accordance with Rule 73;

5. excess insurance in accordance with Rule 74;

6. evidence of a safety committee and an effective written injury prevention program in accordance with section 48-443, and;

7. evidence of compliance with any other requirements under the Act and these rules.

C. After reviewing the application and all supporting documentation and other information the court will send written notice of approval, denial, or requirements for further consideration. If the court has additional requirements, the employer will have 30 days to comply. Upon receipt of a written request the court, at its discretion, may grant the employer additional time to comply. If all requirements are not met within the time prescribed, the application shall be considered withdrawn.

D. A certificate of approval to self-insure will be provided upon approval. The term of approval will be included on the certificate.