58-20-27. Application for self-insurance association--Form.
An association proposing to self-insure its workers' compensation liability shall apply to the department for the authority to self-insure, using forms available from the department. The application shall include:
(1)The association's name;
(2)The location and mailing address of the association's principal office and where its books and records are kept;
(3)The name and address of each member of the association;
(4)A copy of the bylaws or plan of operation adopted by the association;
(5)Proof of compliance with §58-20-28;
(6)A sample copy of the agreement between the association and the members securing the payment of each member's workers' compensation liability;
(7)A pro forma financial statement, on a form acceptable to the department, showing the financial ability of the association to pay the workers' compensation liability of its members; and
(8)The required application fee.
Source: SL 1995, ch 282, §3.
Structure South Dakota Codified Laws
Chapter 20 - Workers' Compensation Insurance
Section 58-20-1 - Definition of terms.
Section 58-20-2 - Policies subject to chapter.
Section 58-20-3.1 - Premiums based on certain wages prohibited.
Section 58-20-4 - Separate coverage of workers' compensation liabilities.
Section 58-20-10 - Notice to either employer or insurer--Required policy provision.
Section 58-20-11 - Provision relieving insurer from payment on insolvency of insured prohibited.
Section 58-20-13 - Form of insurance to be approved before issuance--Ruling subject to appeal.
Section 58-20-14 - Cancellation of policy--Notice of intention to cancel--Service on employer.
Section 58-20-16 - Reinsurance reserve--Amount required.
Section 58-20-20 - Annual statement--Inclusion of experience schedule.
Section 58-20-22 - Premium reductions and premium increases for certain insurers.
Section 58-20-23 - Liability for indemnity compensation or medical loss defined.
Section 58-20-24 - Policy to provide medical services and health care.
Section 58-20-25 - Terms as used in §§ 58-20-25 to 58-20-40.
Section 58-20-26 - Electric utilities authorized to form self-insurance associations.
Section 58-20-27 - Application for self-insurance association--Form.
Section 58-20-28 - Requirements to obtain self-insurance certificate.
Section 58-20-29 - Granting self-insurance application--Revocation.
Section 58-20-30 - Examination of self-insurance association's activities and records.
Section 58-20-31 - Promulgation of rules governing self-insurance associations.
Section 58-20-32 - Voluntary termination of participation in self-insurance association.
Section 58-20-33 - Involuntary termination of membership in self-insurance association.
Section 58-20-35 - Annual report of affairs of self-insurance associations.
Section 58-20-36 - Dissolution of self-insurance association to be approved by department.
Section 58-20-37 - Deficiency of self-insurance associations made up by members.
Section 58-20-38 - Revocation of self-insurance association's certificate.
Section 58-20-39 - Self-insurance association not an insurance company.
Section 58-20-40 - Proceedings or investigations by department.