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 in connection with the employer's California operations. (For information about the experience period, see Section III, Rule 2 of the Experience Rating Plan.)

Submitting Self-Insured Data

Insurers can request to use California self-insured data for experience rating purposes by submitting Form 701, Report of California Self-Insured Data For Experience Rating Purposes, along with applicable loss reports. Authorized representatives from both the insurer and employer must sign this form to verify the completeness and accuracy of the information stated in the form and the self-insured data that will be submitted to the WCIRB. Insurance brokers/agents may not sign this form on behalf of the employer or insurer.

Any change in operations resulting in a reclassification of operations during the five years preceding the effective date of the requested experience modification must be explained in writing.

If the employer’s business underwent a change in ownership during the last five years, a notification of change in ownership and/or combinability of entities must be submitted to the WCIRB using the Ownership Information Submission feature in WCIRB Connect. See the Ownership Changes section of the website for more information.

Requesting insurers are strongly encouraged to submit the self-insured payroll and loss data electronically in a WCSTAT format consistent with that used to submit unit statistical data on insured policies; otherwise, beginning with requests received January 1, 2018, a $500 processing fee will be charged for each request.

The self-insured data is subject to the same validation that applies to all unit statistical report data submitted in accordance with the rules set forth in Part 4, Unit Statistical Reporting Requirements, of the Uniform Statistical Reporting Plan. Self-insured data determined to be acceptable is eligible for use in experience rating.

If the prior valuation of self-insured data contained open claims, or if previously reported closed claims were subsequently reopened and/or revalued with different incurred indemnity and/or incurred medical amounts, or if one or more new claims were subsequently reported, a separate request as well as the subsequent valuation of self-insured claims must be submitted by the insurer providing coverage for the period the proposed experience modification using this subsequent valuation of claims will be in effect.


If you have questions concerning the reporting of self-insured data for experience rating, please contact the WCIRB Contact Center at (888) 229-2472 or [email protected].