Provided below is information necessary to license an individual or group entity as a Self-Insurer for Workers' Compensation. If you have additional questions about this, contact our Alternative Risk unit.
- Initial Application for Individual Workers’ Compensation Self-Insurance Authority (PDF)
- Workers’ Compensation Individual Self-Insurance Authority Renewal Application (PDF)
- Initial Application for Group Workers' Compensation Self-Insurance Authority (PDF)
- Group Workers’ Compensation Self-Insurance Authority Application for Renewal (PDF)
- Regulatory Funding Worksheet (RFW) for Group Self-insurers (XLS)
- Application for Establishment of Alternative Reinsurance Account for Self-Insured Groups (PDF)
- Fee Schedule (24-A M.R.S.A. §601(16) -- (Scroll down to 16)
- Authorization of Credit Card Payment (PDF)
Annual Reporting Requirements
- Bulletin 320 (PDF) (Certification of Compliance with Prohibition against Political Contributions)
- Rule Chapter 250 (DOC) (Requirements for Eligibility to Self-Insure Workers' Compensation Benefits)
- Title 39-A M.R.S.A. Workers' Compensation
The documents on this page are also available in hard copy by contacting the Bureau.