Minnesota Administrative Rules
Agency 120 - Commerce Department
Chapter 2780 - WORKERS' COMPENSATION SELF-INSURANCE
INDIVIDUAL SELF-INSURERS
Part 2780.1100 - APPLICATION FOR SELF-INSURER STATUS

Subpart 1. Procedure.

Each employer desiring to self-insure individually shall apply to the commissioner on forms available from the commissioner. The commissioner shall grant or deny the application within 30 days after a complete application is filed. Such time limit may be extended for another 30 days upon 15 days' prior notice to the applicant. Any grant of authority to self-insure shall continue in effect until revoked by order of the commissioner or until such time as the employer becomes insured.

Subp. 2. Certified financial statement.

Each application for self-insurance shall be accompanied by a certified financial statement. Certified financial statements for a period ending more than six months prior to the date of the application must be accompanied by an affidavit, signed by a company officer under oath, stating that there has been no material lessening of the net worth nor other adverse changes in its financial condition since the end of the period.