Marcia Hultman

Cabinet Secretary

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Workers' Compensation

Self-insured Companies

Self-insured Companies effective Sept. 1, 2018 – Aug. 31, 2019

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
Regional Health, Inc.
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 Aug. 31, 2019. 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 $2,250.

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, $2,250 application fee, and the most recent four years of annual reports.

The Self-Insurance Application and Aggregate Surety Bond are available on our Forms page.

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.