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Office of Self Insurance Plans (OSIP)

Private/SIG Self Insurance by the Numbers – 2014

$90 Billion total self insured payroll
2.2 Million CA Public Workers covered by self insurance
3,579 CA Public Agencies self-insure WC Liabilities
5.45 Billion Estimated Claims Reserves (EFL)
1.53 Billion Medical and Indemnity Payments
93,850 Open Workers’ Compensation Case

Self Insurance Groups

The Office of Self Insurance Plans (OSIP) authorizes qualified employers to provide their own coverage for workers’ compensation liabilities. Small and medium-sized businesses have the option of joining with others in the same industry to self-insure their workers’ compensation liability as a group. All Self Insurance Groups (SIGs) must be approved by OSIP and are required to post a security deposit covering their actuarial determined liabilities. California has one of the largest self-insurance programs in the nation and has some of the strongest regulations designed to ensure the system protects both employers and employees.

GROUP FORMS - Below are forms for use that are specific to groups.

  • Form A4-3 (1/94) ( pdf format, 89K)
    Application for a certificate of consent to self insure by a group of employers
  • Form A4-3M (1/94) ( pdf format, 88K)
    Application for an affiliate certificate of consent to self insure as a member of a group self insurer
  • Form A4-5 ( pdf format, 431K)
    Application for a permanent certificate of consent to self insure by an interim self insurer
  • Form A4-7 ( pdf format, 244K)
    Request for Interim Certificate for a Group Member