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OhioBWC - Employer - Form: (SI-7) - Introduction

Application for Renewal of Authorization to Operate as a Self-insured Policy (SI-7)

Self-insuring employers must use this form to renew their self-insurance status. Failure to complete this form and provide all requested information will mean that BWC will terminate the employer's right to self insure and return the policy to the state fund.

IMPORTANT: The Ohio self-insuring program administrator, as designated by the employer, or an officer of the company must sign all properly completed renewal forms. All renewal forms must be submitted to BWC 90 days prior to the company's renewal date. Additional SI-7 submission information

Required information
  • Renewal date
  • Employer name
  • Employer federal tax ID number
  • Employer address
  • Number of Ohio employees as of application date
  • Employer corporate contact person
  • Employer corporate phone number
  • Employer type of entity
  • Employer state of incorporation
  • Employer date of incorporation
  • Whether company carries excess workers' comp insurance
  • Whether corporate name, structure or address has changed during the past year
  • Calendar and/or fiscal year ending
  • Ohio assets amount
  • Ohio gross payroll amount
  • Claim files maintained

New! If you carry excess insurance on your workers' compensation policy, we now require you to send us a copy of your declaration page for our records. In addition, if your excess insurance carrier is paying any claims, we also need you to send us a list of those claims. The best way to send this information is via email.

IMPORTANT: Be sure you have all required information and additional documentation before you begin. Once you start completing the renewal form, the system will automatically time out after 20 minutes of inactivity. If this occurs, you will have to start over.

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