Self Insurance

Introduction: This section is intended for employers who are currently self-insuring their workers' compensation liabilities in Montana or for employers who desire to apply to be self-insured in Montana. 

New Since 2001: the self-insurance applications are available in either (1) Microsoft Excel format or (2) Adobe PDF format. These two versions can be found on the internet at the links in the left menu:

(1) The Microsoft Excel Version. Please fill in your application information in the colored cells of the Microsoft Excel form. The totals on page 2 of the application are calculated automatically (accidents by year, claims by year, three-year average, unpaid liability, and cash pay-outs). Dates should be entered as mm/dd/yyyy (month, day, year). You may send the application via email to speed up the application process, but we will still need a hard copy of the application that includes your signature.

(2) The Adobe PDF application version has been designed for you to print out on your local printer, so you can then fill in the appropriate information by typewriter or pen.

The instructions for completing the application are in Microsoft Word.

We will still mail out your renewal application packet 30 days before the due date.

These changes and improvements are intended to provide better customer service. We welcome your comments and suggestions.

Applications:

Instructions

Self-Insurance Fillable Application

Self-Insurance Excel Application

Employers and Employer groups that previously self-insured their workers' compensation liabilities in Montana (Plan 1) remain subject to Montana Department of Labor jurisdiction as long as there are any open or re-opened claims, any outstanding liabilities for the self-insured period, or any disputes existing concerning payment of any self-insured claim. The Department requires periodic updates on the employer’s workers' compensation and occupational disease claims for the self-insured period.

The Department’s self-insurance financial / loss update form is the required format for this update and is available below in Adobe PDF under the Cancelled Carrier Update tab. A Microsoft Excel version of the form is also available by contacting us using the contact information listed below.

All prior Plan 1 carriers are required to submit the completed self-insurance financial / loss update form by January 31st each year along with a copy of the most recent annual report or audited financial statement. You may also send your update electronically to the contact information listed below.

Forms:

Cancelled Carrier

Cancelled Carrier (Excel)

LIST OF SELF-INSUREDS

As of January 1, 2024, there were twenty-three individual self-insured employers, three private groups representing 104 member employers and four public groups representing 373 member employers.  The listing below represents a complete listing of the currently authorized self-insureds in Montana as of January 1, 2024.  Please note that §2-6-109, MCA (Montana Code Annotated) prohibits the use of this information for a mailing list without our agency first securing permission of those entities on the list.

 

INDIVIDUAL SELF-INSUREDS

 Albertsons Companies, Inc.

 Benefis Health System Inc.

 CHS Inc.

 Costco Wholesale Corporation

 F.H. Stoltze Land & Lumber Company

 Federal Express Corporation

 FedEx Freight Inc.

 FedEx Ground Package System Inc.

 Harnish Group Inc.

 Intermountain Healthcare (Sisters of Charity of Leavenworth Health System)

 J H Kelly LLC

 Kroger

 Les Schwab Tire Centers of Montana, LLC.

 Logan Health (fka Kalispell Regional Healthcare System)

 NorthWestern Corporation

 Old Dominion Freight Line, Inc.

 Providence Health & Services

 Rosauers Supermarkets Inc.

 Roseburg Forest Products Company

 Ryder Systems Inc.

 Stillwater Mining Company

 Target Corporation

 Weyerhaeuser NR Company

 

PRIVATE SELF-INSURED GROUPS

 Montana Contractor Compensation Fund

 Montana Electric & Telephone Pool

 Montana Health Network Workers’ Compensation Insurance Trust

 

PUBLIC SELF-INSURED GROUPS  

 Missoula County Workers’ Compensation Group Insurance Authority

 Montana Municipal Interlocal Authority

 Montana Schools Group Interlocal Authority

 MUS Self-Funded Workers’ Compensation Program

39-71-2101 et. seq. MCA

The department determines whether an employer has the requisite financial ability to pay workers' compensation indemnity and medical benefits and, if so, grants the employer permission to self-insure their workers' compensation liabilities. 

An applicant for self-insurance is required to submit an application along with audited financial statements, or reviewed statements if audits are not normally prepared. The financial statements are reviewed and financial ratios are computed and compared to other businesses in the same industry to determine the strength of the business and its ability to make workers' compensation payments when due.

Actuary Reports - An actuarial analysis of workers’ compensation claims is required to be submitted with your self-insurance application. We only require the actuarial analysis for the Montana self-insured workers’ compensation claims. This report will be held as Confidential Information. The objective of the Actuarial Analysis Report is to estimate the ultimate liability for Montana self-insured outstanding claims as of December 31 each year. We want to know the total liability, year-by-year breakdown of the total liability, the ultimate cost of claims incurred. The estimate should include a provision for case reserves; future development on reported claims, liability for claims incurred but not yet reported, and reopened claims.

Amber Weekes
(406) 444-7748
amber.weekes2@mt.gov

Mailing Address
Self Insurance
Employment Relations Division
PO Box 8011
Helena, MT 59604-8011