Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-190 - RULES FOR SELF-INSURERS UNDER THE WORKERS' COMPENSATION ACT › Section 69O-190.056 - Application for Self-Insurers Fund

Current through Reg. 50, No. 138; July 16, 2024
(1)
				Licensing procedures pursuant to Section
				120.60, F.S., and in accordance
				with the model rules of procedure shall apply to this application.
(2) All applications for a self-insurers fund
				shall be made in writing on OIR Form BSI-2.
(3) All applications shall be accompanied by:
(a) A properly completed indemnity agreement
				in accordance with Rule
				69O-190.068, F.A.C.
(b) A properly executed Self-Insurer's Surety
				Bond on OIR Form BSI-4, pursuant to Rule 69O-190.032 and subsection
				69O-190.060(4),
				F.A.C., or proof of cash securities pursuant to Rule 69O-190.033, F.A.C., and
				in amounts pursuant to Rule
				69O-190.060, F.A.C.
(c) Copies of acceptable excess insurance
				policies pursuant to Rule 69O-190.035, F.A.C., with limits and retentions
				pursuant to Rule 69O-190.061, F.A.C., and
				endorsements pursuant to Rule 69O-190.036, F.A.C.
(d) A fidelity bond or insurance policy
				pursuant to subsection
				69O-190.064(5),
				F.A.C.
(e) A fidelity bond or
				insurance policy covering the service company pursuant to subsection
				69O-190.064(7),
				F.A.C.
(f) A certification from a
				designated depository attesting to sufficient monies on hand in order for the
				fund to meet initial obligations pursuant to paragraph
				69O-190.056(5)(c),
				F.A.C.
(g) Proof of servicing
				pursuant to Rule 69O-190.031, F.A.C.
(h) Copies of the fund by-laws or trust
				agreement and written policies pursuant to subsections
				69O-190.064(2), (3) and
				(4), F.A.C.
(i) Membership applications executed on OIR
				Form BSI-3 or its equivalent complete with declarations and financial
				statements pursuant to Rule
				69O-190.059, F.A.C. Funds must
				use the BSI-3 unless prior approval of the Office has been granted for use of
				an alternate form. Such alternate form must contain all information contained
				on the BSI-3, but may ask for additional information or use a different format.
				Approval will be granted if the alternate form contains all required
				information. OIR Form BSI-3, or its equivalent, shall be used for all new
				business. OIR Form BSI-3, or its equivalent, shall be used for all renewal
				business for twelve consecutive months. The use of this form for new and
				renewal business must commence within sixty (60) days of the date of this rule.
				A copy of this form may be obtained from the Bureau of P & L Insurer
				Solvency, Tallahassee, Florida.
(j)
				Proof that the initial membership of the fund have the combined financial
				conditions and combined premiums as specified in paragraph (m) of this
				section.
(k) The name of the
				attorney, certified public accountant, and actuary representing the
				fund.
(l) A completed Estimated
				Breakdown of Policy Year Expenses on OIR Form BSI-21.
(m) Each self-insurers fund shall submit a
				current financial statement on each member at the inception of the
				self-insurers fund showing the combined net worth of all members applying for
				coverage to be not less than $1,000,000, each member shall have a current ratio
				which is the median for the self-insureds standard industry code as published
				in the 1992 edition of the Robert Morris Associates Annual Statement Studies.
				An audited financial statement or a financial statement properly certified by
				an officer, owner or partner for all members joining the self-insurers fund
				after the inception date shall be submitted to the Office with the application
				for membership until such time as an audited financial statement is available
				for the self-insurers fund as a whole. In no event shall the cumulative net
				worth or current ratio of the combined assets and liabilities of all members be
				less than the minimum amounts currently required for a fund to
				qualify.
(n) Each applicant shall
				submit a feasibility study, prepared by an independent qualified actuary and an
				independent certified public accountant to satisfactorily address market
				potential, market penetration, market competition, operating expenses, gross
				revenues, net income total assets and liabilities, cash flow, and such other
				items as the division may require. The study shall be for the greater of 3
				years or until the arrangement has been projected to be profitable for 12
				consecutive months. The feasibility study must reflect and support all premium,
				reserve, and other financial requirements with which the fund must
				comply.