Once a year, self-insuring employers must complete the SI-40 online. We'll NO longer accept hard-copy forms. Instead, we'll send an email notice to all self-insuring employers with a link to the SI-40 every January. Self-insuring employers must submit the information no later than Feb. 28. Self-insuring employers must also submit a back-up report that supports each of the payment categories. This information assists BWC's self-insured department in validating the accuracy of the SI-40 information. For more details about this back-up report, click here.

The SI-40 captures all paid compensation the employer has paid in the reporting year by type. Based on the total amount of paid compensation reported, BWC calculates the self-insuring employer’s semiannual assessment. The assessment covers safety & hygiene, the administrative cost fund and the surplus fund. This assessment also covers the portion of the surplus fund used for rehabilitation reimbursement and disability reimbursement subject to the self-insuring employer's election.
Note: Lost-time, Medical-only, Occupational disease and Death fields ask for the number of claims in the reporting year.

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