Completed applications are to be sent in duplicate to the State Board of Workers' Compensation along with three 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, one copy 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 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 $4,000. (For a copy of the application, please go to the "Forms" section of this site.)

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. NO DEVIATIONS WILL BE ACCEPTED.

• If the parent company and its subsidiaries/affiliates are self-insured under the parent’s name, it is required that the language, “and self-insured subsidiaries and affiliates, if any” be placed after the parent company’s name in the “employer” section. It is no longer permissible to list individual subsidiaries and affiliates.

For copies of the approved language for letters of credit and the surety bond form along with detailed instructions for the issuance of both forms of security, please see the “Forms” section of this site. PLEASE NOTE: Letters of credit must be issued or confirmed by a Georgia depository. NO EXCEPTIONS WILL BE GRANTED.

The amount of the required security is stated on an Order issued by the State Board of Workers' Compensation. For information related to the setting of security requirements, please see the “News” section of this site for discussion dated 10/14/2003.

Cancelled members are required to keep security on file for a minimum of two (2) years from the closure of their last claim. For more information, please see the “Topics” section of this site for the discussion entitled “Cancellation of Self-Insurance”.

1. Self-Insured companies are required to purchase specific excess workers' compensation coverage. Proof of this coverage must be sent to the Georgia Self-Insurers Guaranty Trust Fund or the State Board of Workers' Compensation annually.
2. The workers' compensation limits of the policy must be "statutory".
3. The self-insured specific retention amount must be "per accident" or "per occurrence."
4. All of the items below must be stated on each and every policy, declaration page, or certificate of insurance associated with the policy.
   1. The insurance company that issued the policy
   2. The effective date of the policy
   3. The expiration date of the policy
   4. The self-insured specific retention amount of the policy followed by "per accident"
   5. The workers' compensation limits of the policy, which must be "statutory".
   6. A statement that the policy is a specific excess workers' compensation policy
   7. The companies insured by the policy, which must state the self-insured's name followed by "and self-insured subsidiaries and affiliates, if any".
   8. States of Self-Insured Operation must list Georgia.
5. Georgia Self-Insurers Guaranty Trust Fund" must be listed as a party on the cancellation endorsement; otherwise, the "Georgia Self-Insurers Guaranty Trust Fund" must be listed as a certificate holder.  Please see FORMS for acceptable Georgia Endorsements.
6. The specific excess workers' compensation policy must include an endorsement which states the following:
   

   IN THE EVENT OF THE BANKRUPTCY OR INSOLVENCY OF THE NAMED INSURED:
   If the Georgia Self-Insurers Guaranty Trust Fund is called upon to expend monies on behalf of the insolvent or bankrupt member insured under this policy in order to pay workers' compensation benefits, medical expenses or other costs pursuant to O.C.G.A. 34-9-1, et seq., we will reimburse the Georgia Self-Insurers Guaranty Trust Fund for those amounts according to the terms of the policy. This provision is subject to the policy terms, retention(s) and limit(s). The Georgia Self-Insurers Guaranty Trust Fund will be treated as the insured for purposes of reimbursement pursuant to this endorsement and payments made by the bankrupt insolvent named insured will be credited towards the retention for the benefit of the Georgia Self-Insurers Guaranty Trust Fund.

                           PLEASE NOTE: Only insurance companies with an AM Best rating of "A minus" or better are acceptable.