Texas Administrative Code
Title 28 - INSURANCE
Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION
Chapter 114 - SELF-INSURANCE
Section 114.3 - Application Form and Financial Information Requirements
Current through Reg. 49, No. 38; September 20, 2024
(a) Employers shall submit an application by filing a completed and signed application in the form and manner prescribed by the commissioner and must include:
(b) Incomplete applications may be returned to the applicant.
(c) An incomplete application may be treated as voluntarily withdrawn if the applicant fails to respond to any request for information by the division for more than 90 days from the date the request is deemed received by the applicant, as provided by division rule.
(d) The sworn affidavit required on any self-insurance application or other document requiring a sworn affidavit also applies to all attachments, additions, and any subsequent amendments to those documents.
(e) If the financial statements under subsection (a)(2) of this section are dated more than six months prior to the date of the application, interim financial statements may be required.
(f) Applicants will be evaluated for stability and financial strength. Applicants shall provide information relevant to the factors specified in Texas Labor Code § 407.061 and § 407.062 and shall ensure that a credit or debt rating and an analysis of that rating have been prepared by one of the following:
(g) In addition to reviewing the information required in subsection (f) of this section, the commissioner shall consider the applicant's: