Department of Labor and Regulation

Title - Workers' Compensation

Self-insured Companies

Self-insured Companies effective September 1, 2016 - August 31, 2017

Avera Health
Cold Springs Granite Company
Dakota Granite Company
Federal Express Corporation
Jeld-Wen, Inc.
John Morrell & Company
Kohl's Department Stores
MidAmerican Energy Company
NorthWestern Energy
Otter Tail Power Company
Target Corporation
Tyson Foods, Inc

Self-Insurance Application Policy

The self-insurance year commences on September 1 and ends on August 31 of the following year. All current certificates of exemption will expire on August 31, 2015. All employers currently approved to self-insure their workers compensation liabilities are required to submit a renewal application, along with their most recent annual report and the nonrefundable application fee in the amount of $2,000.

If you are currently self-insured, you do not need to resubmit a new security form unless that form of security or amount is being changed.

New applicants must submit their application, security form, $2,000 application fee, and the most recent four years of annual reports.

The application and aggregate surety bond (in Adobe .pdf format*) is available on this website.

As indicated in the application, every question must contain a response or indication that the question is not applicable. Any application containing questions that have not been responded to may be returned to the applicant for completion. Any delay in the completion of the application may result in a delay in granting approval to self-insure.

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Marcia Hultman, Secretary
123 W. Missouri Ave.
Pierre, SD 57501-4505
Tel. 605.773.3101
Fax. 605.773.6184