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Mar 1 2020

Self insured workers compensation / Video

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Self insured workers compensation

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Self-Insurance Authority Information

Accounting Division
Self-Insurance and Tax Office
800 W Washington St, Room 301, Phoenix AZ 85007

SELF-INSURANCE AUTHORITY INFORMATION

Minimum Qualifications for Applying for Self-Insurance Authority

  • Annual payroll of at least $2,000,000 (this may include the payroll of included subsidiaries)
  • Total assets of $50,000,000 or a cash flow ratio of at least 0.25
  • Have conducted business in Arizona for a minimum of 5 years (business can be conducted through a domiciled subsidiary company)

Under the provisions of A.R.S. § 23-961 and § 23-961.01, the Self-Insurance Office processes all initial and renewal applications from individual or group employers requesting authority to act as a self-insured entity for workerscompensation. Application forms may be found here.

Benefits of Being a Self-Insured Employer in Arizona

INFORMATION ON OBTAINING ARIZONA WORKERS’ COMPENSATION INSURANCE

Click for list of insurance carriers authorized to write workerscompensation policies in Arizona
Or
Contact the Independent Insurance Agents & Brokers of America at www.iiaba.net. (Go to search for Agent or Broker. When conducting a search, a specific Agent or Broker name is not required. However, please be sure to put the City and State in required fields. This will populate a complete Insurance Agent and Broker list for Arizona.)

Declined by two insurance carriers? You may qualify for the Assigned Risk Pool. For more information about the Assigned Risk Pool, please go to www.ncci.com. The Assigned Risk Pool information can be found under the residual market section of the website. The NCCI Assigned Risk can also be contacted at 505-242-1330 for more information.

Self-Insurance Manager
Renee Pastor
Phone: (602) 542-1839
FAX: (602) 542-3070
Email: [email protected]

Workers’ Comp Tax Accountant
Kamen Kovatchev
Phone: (602) 542-1836
FAX: (602) 542-3070
Email: [email protected]

Self-Insurance Administrator
Kamen Kovatchev
Phone: (602) 542-1836
FAX: (602) 542-3070
Email: [email protected]

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SOURCE: http://www.azica.gov/self-insurance-authority-information

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