Information for New Companies:
Send an email with your request to selfinsuredworkerscompensation@iid.iowa.gov with your request. We will send you an electronic application to complete, along with the necessary instructions.
Other required documents are:
- $200.00 Fee ($100 Application Fee + $100 Certificate Fee)
- Audited Financial Statement
- Actuarial Opinion
- Certificate of Excess Insurance
- Self Insurance Security Bond
- Parental Guarantee for Subsidiaries
Information for Renewing Companies:
Electronic applications will be sent to the prior years designated contact in early April. Completed applications are to be submitted electronically to selfinsuredworkerscompensation@iid.iowa.gov no later than June 1.
Other required documents are:
- $200.00 Fee ($100 Application Fee + $100 Certificate Fee)
- Audited Financial Statement
- Actuarial Opinion
- Certificate of Excess Insurance
- Self Insurance Security Bond
- Parental Guarantee for Subsidiaries