16 Va. Admin. Code § 30-80-30 - Applications for self-insurance

A. Applicants for individual self-insurance shall meet the following minimum requirements:

1. At least three years of operation under the current corporate identity.

2. Positive tangible net worth.

3. No fewer than 50 full-time employees within Virginia, except that for applicants with more than 250 employees in all U.S. jurisdictions this requirement will be waived.

4. No more than one net loss within the last three years.

5. A current ratio, based on audited figures, of at least 1.00, except that upon satisfactory and acceptable proof from the applicant that the median current ratio for the applicant's industry is less than 1.0, that median ratio shall be used as the minimum standard.

6. A debt/equity ratio (total liabilities to net worth), based on audited figures, of less than 2.2, except that upon satisfactory and acceptable proof from the applicant that the debt/equity ratio for the applicant's industry is greater than 2.2, that median figure shall be used as the minimum standard.

B. All applications for self-insurance must be submitted on the current version of the Employer's Application for Individual Self-Insurance (VWC Form No. 20).

C. All applications must be filled out completely and signed by an officer of the applying corporation, or by an agent authorized by the board of directors or trustees.

D. All applications must be accompanied by:

1. The latest three years of audited financial statements.

2. The latest three years of detailed claims information.

3. An overview of program operations (if this is not included with the financial figures as part of an annual report).

4. A nonrefundable application fee in the amount currently set by the commission.

Notes

16 Va. Admin. Code § 30-80-30

Derived from VR405-20-01 § 3, eff. January 13, 1993; amended, Virginia Register Volume 12, Issue 25, eff. October 2, 1996.

Statutory Authority

§ 65.2-201 of the Code of Virginia.