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Reporting Self-Insured Data for Experience Rating

The California Workers' Compensation Experience Rating Plan -1995 (Experience Rating Plan) permits the use of California payroll and loss data developed while an employer was legally self-insured to be used to compute an experience modification. The California operations that developed the data must be covered by a workers' compensation insurance policy for the period during which the experience modification will be in effect and the WCIRB must be in receipt of the policy. The self-insured data is subject to all rules of the Experience Rating Plan  and the California Workers' Compensation Uniform Statistical Reporting Plan - 1995  (Uniform Statistical Reporting Plan).

An experience modification will not be promulgated with partial self-insured data. Requests to use self-insured data must include all the self-insured payroll and loss data developed within the experience period (for information about the experience period, see Section III, Rule 2 of the Experience Rating Plan).

Submitting Self-Insured Data

Insurers that wish to submit self-insured data to the WCIRB must use Form 701, Report of California Self-Insured Data For Experience Rating Purposes . When the insurer has submitted the required information to the WCIRB, it will be reviewed by the WCIRB in the same manner in which all unit statistical report data is reviewed. Once it has been determined that the information is complete and has passed all required edits, the WCIRB will publish the requested experience modification using the self-insured data.

If the self-insured data (original report) includes open claims, all such claims must be revalued and a subsequent Form 701 must be submitted annually to the WCIRB in accordance with the rules set forth in the Uniform Statistical Reporting Plan. See the examples below.

If the self-insured employer(s) underwent a change in ownership during the last five (5) years, the ownership change must be submitted through the Ownership Information Submission feature in WCIRB Connect. See the Ownership Changes section of the website for more information. No data developed prior to a material change in status can be used to compute an experience modification.

Examples of Completed Self-Insured Data Submissions

First Report

The insurer, Northwest Workers' Compensation Insurance Company, requests that the data of Solara Plastics, Inc. be used to promulgate an experience modification effective January 1, 2013 - the employer's anniversary rating date. Form 701 is used to report Solara's self-insured data for the period of January 1, 2009 to January 1, 2012. Prior to January 1, 2009, Solara was insured by XYZ Insurance Company. This form is checked as a "First Report (Original)" since this submission represents the initial or first reporting of the self-insured data. Loss reports valued as of July 2012 were included with the submission (in accordance with USRP, Part 4, Section I, Rule 2).

Subsequent Report

For the next proposed rating date of January 1, 2014, a subsequent report (revaluation of claims) must be filed in accordance with the Uniform Statistical Reporting Plan. Accordingly, the form is checked as "Subsequent Report (Revaluation of Claims.)" This subsequent report provides a valuation of any open claims from the first report that fall within the experience period for the January 1, 2014 experience modification.  It is not necessary to report the payroll or any claims that were reported as closed on the previous report, unless there has been a change in the value and/or status of the claims.

In the example provided, there are four (04) open claims that must be revalued for the January 1, 2014 experience modification (the open claims reported on the January 1, 2010 and January 1, 2011 policy years.) Loss reports valued as of July 2013 were included with the submission. These revalued claims will be used to promulgate the employer's next experience modification, effective January 1, 2014.


If you have questions concerning the reporting of self-insured data for experience rating, please contact your insurance professional (agent, broker or insurer) or WCIRB Customer Service at (888) 229-2472 or [email protected].