Frequently Asked Questions
What are the benefits in being self-insured versus insured through an insurance company?
Self-insured companies experience:
(1) An improved control of workers’ compensation claims;
(2) A reduction in overall costs of workers’ compensation claims;
(3) An improvement in the relationship with injured employees;
(4) More enthusiastic support of safety efforts;
(5) An improved cash flow.
I am the new member contact for my company, how do I notify the Georgia Self-Insurers Guaranty Trust Fund of this change?
Please submit your name, address, telephone number, fax number, and e-mail address on your company’s official letterhead to our office and we will gladly update our records accordingly. Please note, it is the member’s responsibility to notify us and the State Board of Workers Compensation of any contact changes.
What if there are any special circumstances or changes in the company?
If there are any special circumstance, please contact the Georgia Self-Insurers Guaranty Trust Fund at 404-872-6184, by e-mail at firstname.lastname@example.org, or by mail at P.O. Box 7159, Atlanta, GA 30357.
How do I go about adding a subsidiary company to our self-insurers program?
If a self-insured employer purchases another company and desires the newly-acquired company to be added to its self-insurance, the self-insured company must submit its request in writing to the Georgia Self-Insurers Guaranty Trust Fund. Along with its letter, the self-insured company must supply information related to the workers' compensation claims and employment of the newly-acquired company. For a copy of the form to be provided to the Georgia Self-Insurers Guaranty Trust Fund with the request, please refer to the website under the “Other Topics” section.
NEW APPLICATIONS FOR SELF-INSURANCE
What are the requirements for self-insured membership in Georgia?
Companies seeking self-insurance in Georgia should send a complete, original Confidential Application for Self-Insuring Employers and Private Hospital Authorities, along with one copy of the application, to the State Board of Workers' Compensation, along with three years of audited financial statements, and an 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, one copy of the application, the financial statements, and the application fee are sent to the Georgia Self-Insurers Guaranty Trust Fund.
If the application is complete, the Trustees of the Georgia Self-Insurers Guaranty Trust Fund review the application and financial statements, and make a recommendation to the State Board regarding the acceptance of the applicant for self-insurance. The State Board has final authority regarding the acceptance of any applicant, and will issue an Order accepting or rejecting the applicant. The State Board'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 of $8,000.
Please refer to the website for the application form.
How long does it take to process of a new member application?
The time frame for review of the new member application varies based on the accurate completion of the application itself; however, we estimate about 2-3 months.
Are there any application fees and assessment waivers?
No application or initial assessment fees are waived.
What are the initial fees for a new member application?
There is a $500 application fee, and, if approved, there is an initial assessment of $8,000.
How is security calculated?
The amount of security required by a self-insured employer is based on the greater of two figures: (1) reserves, which is determined by the State Board of Workers’ Compensation and the Georgia Self-Insurers Guaranty Trust Fund for all employers’ outstanding claims, or (2) twice the annual average of the employers’ cumulative medical and indemnity benefits paid during the most recent three (3) year calendar period. However, the Board of Trustees can denote from this procedure at their discretions if an employer poses a heightened risk to the Fund.
How and when do I request a security reduction?
On the home page of our website, see Request for Security Reduction under the “Annual Requirements” tab, then under the “Security” tab.
What is the process if there is an error with the security on file?
A letter will be sent to the member indicating any and all discrepancies with the security submitted and the due date for corrections.
How do I obtain a return of security after cancelling self-insurance?
In order for a cancelled member to have their security returned, the following criteria must be met: (1) All cancelled members must have been 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 cancelled member cannot have made any payments during the last twelve (12) months, and must confirm that they have not received any unpaid medical invoice(s) over this same period; (4) The cancelled member must confirm that no indemnity has been paid in the last three (3) years, and confirm the amount of medical paid over the last three (3) years.
How is the assessment calculated?
Annual assessments are calculated off of 1.5 percent of medical and indemnity reported for the previous year on the Member Information Update Form. If there is no indemnity or medical paid, then the assessment will be the minimum amount, which is $2,000.
What are the minimum and maximum amounts that may be assessed annually?
The minimum assessment is $2,000, and the maximum assessment is $8,000.
My company is no longer self-insured, why do we have to pay an assessment?
Members continue to be assessed until they have been cancelled for at least two (2) years and have not reported any medical or indemnity paid, and/or open medical and indemnity claims for a minimum of two (2) full consecutive years.
How is my company assessed in becoming self-insured?
There is an initial assessment of $8,000 for the first year. After that, the submission of medical and indemnity paid on the annual Member Information Update Form determines assessment fee.
Are there any application fees and assessment waivers?
No application or initial assessment fees are waived.
I have received a request for a State Board hearing, what should I do?
Please contact the Fund immediately to clear up any reason why a State Board of Workers Compensation hearing was requested. State Board of Workers Compensation hearings are requested for past-due submission and/or corrections to the Member Information Update Form, as well as for late submission of payments of assessments and/or penalties.
MEMBER INFORMATION UPDATE FORM
What is the Member Information Update Form?
This form includes a list of questions that members are required to complete every year regarding information for the previous year. For example, the 2010 Member Information Update Form contains data for the 2009 calendar year, including financial information and reserves, as well as current contact information for the member. The purpose of the Member Information Update Form is to collect data to calculate the security on any open claims. The information is beneficial in assessing the company's security. It is also used to ensure that we have current contact information on file.
Should I include claims that have been accepted by SITF or the excess carrier in my data reported on the Member Information Update Form?
No, exclude any claims for which you have executed agreements with SITF for full reimbursement and/or are currently receiving 100% reimbursement from the excess carrier.
My company is no longer self-insured, why do we have to complete a Member Information Update Form?
Please see cancellation of self-insurance for cancelled member requirements. The Member Information Update Form is completed until there is no reporting of medical and indemnity, and there are no open medical or indemnity claims to report for a period of three (3) years. You may also visit the website at www.gaguaranty.com for more information.
What is the turn-around time for completing corrections on my Member Information Update Form?
Typically, the turnaround time for corrections is 30 days. If the corrections have not been received, then a penalty is incurred. The penalty is $50.00 a day, or 10 percent of the assessment, whichever is greater. If there are still corrections needed, then another 30-day time frame is granted to the member to submit corrections.
When does renewal of the Member Information Update Form process begin?
After December 1st, the Member Information Update Forms are sent to all members, active and cancelled. Complete and return the form with all required documents to the Georgia Self-Insurers Guaranty Trust Fund, P.O. Box 7159, Atlanta, GA 30357-0159, no later than March 31.
What if the Member Information Update Form is not returned on time?
The penalty for the late submission of the Member Information Update Form is $50.00 per day, or ten percent (10%) of the assessment, whichever is greater. It is very important to have your Member Information Update Form postmarked no later than March 31st to avoid penalty.
Are there any exceptions for the late submission of the Member Information Update Form?
The only exception is to contact the Georgia Self-Insurers Guaranty Trust Fund prior to March 23 to request an extension. Requests for an extension can be made in writing to the Georgia Self-Insurers Guaranty Trust Fund.
How long is the extension for turning in the Member Information Update Form?
The extension of the due date for turning in the Member Information Update Form is two (2) additional weeks. If the form is not received by the extension date, the Member Information Update Form is late and a penalty will be assessed.
What is excess insurance and will the company need it?
Excess insurance is supplemental insurance above current insurance to cover claims. All self-insured members are required to provide proof of specific excess insurance. If additional insurance is needed, the company will be notified.
How do I know if the insurance company has a Cancellation Endorsement on file with the Georgia Self-Insurers Guaranty Trust Fund?
Please refer to the “Annual Requirements” tab on the home page of the website, and access the “Specific Excess Workers’ Compensation” tab, then the “Cancellation Endorsement” tab.
What are the Specific Excess Workers’ Compensation Cancellation and Bankruptcy Endorsements?
The Georgia Self-Insurers Guaranty Trust Fund must be listed as a party on the Cancellation Endorsement, or the Georgia Self-Insurers Guaranty Trust Fund must be listed as a certificate holder. Please refer to the website for acceptable Georgia Cancellation Endorsements, located under the “Annual Requirements” tab, then under the “Specific Excess Workers’ Compensation” tab. Specific excess workers’ compensation policies must include a Bankruptcy Endorsement. Please refer to the website for the required language to be included in the Bankruptcy Endorsement.
CANCELLATION OF MEMBERSHIP
What is the process of cancelling my membership with the Georgia Self-Insurers Guaranty Trust Fund?
An active member who chooses to cancel its self-insurance must notify the Georgia Self-Insurers Guaranty Trust Fund or the State Board of Workers' Compensation in writing of its intention to cancel its self-insurance, providing the effective date of the cancellation. Although self-insurance is cancelled, the employer will continue to be responsible for claims which occurred during the period of self-insurance. Therefore, the Georgia Self-Insurers Guaranty Trust Fund will maintain the security presently on file, and the employer must submit both Member Information Update Forms and current financials, and will be assessed based upon claims for which indemnity was paid. For more details, please visit our website. On the home page, click on “Cancellation of Self-Insurance”.
What is my responsibility once I cancel membership with the Georgia Self- Insurers Guaranty Trust Fund?
Cancelled members, even though they are no longer self-insured, are required to: (1) complete the annual Member Information Update Form, (2) provide complete, original bound copies of financial statements annually, (3) continue to pay assessments based on the amount of indemnity and medical paid the previous year. A cancelled member will be assessed the first year after cancellation of self-insurance, regardless of whether indemnity or medical were paid the previous year.
What is a claims audit?
A claims audit is a way for the Georgia Self Insurers Guaranty Trust Fund to ensure that all claims made by a member are being reported to the State Board of Workers Compensation, and to ensure that the member has adequate security on file based on the amount of reserves reported. The claims audit is preformed by a licensed independent auditor.
Why is a claims audit performed?
When a member requests a reduction in security, if a member goes bankrupt, or if the Fund is concerned about a member’s financial status, the Board of Trustees will recommend a claims audit. The claims audit is performed in order for the Trustees to make a recommendation on whether a reduction should be granted based on what the auditor uncovers as far as reserves. The auditor’s reserves will be reviewed together with other data to determine if the member has adequate security on file, and if there is an excess amount of security which can be reduced.
What information is needed in order for a claims audit to be performed?
When the Trustees have determined that a claims audit will be performed, and after the State Board of Workers Compensation issues an order granting so, a letter will be sent to the member requesting the following information:
All open and the last two (2) years of closed claims including the following:
Name of the Claimant
Date of Injury
Claimants Social Security Number (last four digits only)
Description of Injury
Medical Paid to Date
Indemnity Paid to Date
Unpaid Medical and Indemnity Reserves
Once this information is received from the member, we will begin the process of putting together a claims comparison report. The member will need to contact the auditor in order to arrange for the company’s audit, and will be given the contact information as well in the letter stated above.
Who is responsible for the cost of the claims audit?
If a reduction in security has been requested by a member the Trustees will often request a claims audit if needed. In this case, the member is responsible for the auditor fees. There are circumstances where the Trustees decide to have a claims audit performed at the expense of the Georgia Self Insurers Guaranty Trust Fund. This will be the case when a member has become a “going concern.” However, this situation is not all inclusive.