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TEXAS WORKERS' COMPENSATION SELF-INSURANCE GROUPS

The Company Licensing and Registration Office handles filings for Texas Workers' Compensation Self-Insurance Groups (WCSIG). Sponsored by a Texas trade association, employer members may self insure for workers' compensation by forming a WCSIG. Individual employers wishing to self insure for workers' compensation may do so by becoming a certified self-insurer (see Self-Insurance Regulation).

WCSIGs at a minimum must have five employers, within a same/similar industry, sponsored by a bonafide Texas Association. Despite limited regulation, employer members operate under joint and several liable agreements and each WCSIG must be a member of and contribute to the Texas Self-Insurance Guaranty Fund.

To assist the WCSIG industry in regards to statutory/regulatory compliance, the following checklists and form are available. WCSIGs must complete and file the appropriate documents for review and/or approval in order to become licensed, cancel a license, or address any other transaction or compliance function that a WCSIG may enter into.

TDI Form FIN300 (Name Application)
TDI Form FIN404 (WC SIG Acknowledgement of Indemnity Agreement)
TDI Form FIN464 (WC SIG Administrator/Service Company Bond)
TDI Form FIN465 (WC SIG Application for Certificate of Approval)
TDI Form FIN466 (WC SIG Application Checklist)
TDI Form FIN467 (WC SIG Employer Membership Form)
TDI Form FIN468 (WC SIG Notification Form)
TDI Form FIN469 (WC SIG Termination of Certificate of Approval Checklist)
TDI Form FIN470 (WC SIG Merger Checklist)
TDI Form FIN471 (WC SIG 5% Investments Instruction Street)
TDI Form FIN472 (WC SIG Hazardous Financial Condition Notice)
TDI Form FIN473 (WC SIG Changes to Administrator or Service Company Agreements Checklist)
TDI Form FIN474 (WC SIG Change in Security for Incurred Liabilities Form)
TDI Form FIN475 (WC SIG Change in Performance or Fidelity Bond Checklist)
TDI Form FIN476 (WC SIG Changes to Corporate Governance Documents Checklist)
TDI Form FIN477 (WC SIG Excess Insurance Checklist)
TDI Form FIN478 (WC SIG Financial Pro Forma)
TDI Form FIN479 (WC SIG Movement of Books and Records Checklist)
TDI Form FIN480 (WC SIG Increase or Decrease in Membership Checklist)
Instructions for Establishing, Substituting and Withdrawing Securities on Deposit

Texas Administrative Code 28 §§5.6403-5.6413
Labor Code Chapter 407A

Submit filings:

Electronically:

CLRFilings@tdi.texas.gov

or

Standard Mail:

Texas Department of Insurance
Company Licensing and Registration Office, MC 103-CL
333 Guadalupe Street
Austin, TX 78701


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Last updated: 11/04/2016

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