Florida's Statutes and Administrative Rules

It is important that all Private Self-Insured Employers become knowledgeable with Florida's self-insurance statutes and rules. These rules establish the application and termination process, annual reporting requirements and civil penalties for the late reporting of essential information. Please review the self-insurance forms, rules and statutes below and contact the Florida Self-Insurers Guaranty Association, Incorporated with any questions.

Rules:

• Private Self-Insurer Requirements (69L-5.225, F.A.C.)
• Application Process (69L-5.226, F.A.C.)
  • Form SI-1 Application for Self-Insurance (69L-5.226(1), F.A.C.)
  • Form SI-10 Parental Guaranty and Corporate Resolution (69L-5.215, F.A.C.)
  • Form SI-11 Indemnity Agreement (69L-5.214, F.A.C.)
• Reporting Requirements (69L-5, F.A.C.)
  • Form SI-5 Payroll Report (69L-5.203, F.A.C.)
  • Form SI-17 Unit Statistical Report (69L-5.205, F.A.C.)
  • Form SI-19 Certification for Servicing Self-Insurers (69L-5.216(2) & (3), F.A.C.)
  • Form SI-20 Report of Outstanding Workers’ Compensation Liabilities (69L-207, F.A.C.)
  • Specific Excess Insurance Policy (69L-5.207, F.A.C.)
  • Financial Statement (69L-5.209, F.A.C.)
  • Actuarial Report (as determined by FSIGA and the Division) (69L-5.210, F.A.C.)
• Termination (Rule 69L-5.228, F.A.C.)

Statutes:

• Security for compensation; insurance carriers and self-insurers (Section 440.38. F.S.)
• Florida Self-Insurers Guaranty Association, Incorporated (Section 440.385, F.S.)

Mailing Address:

• Florida Self-Insurers Guaranty Association, Incorporated
  427 East Piedmont Drive, 2nd Floor
  Tallahassee, Florida 32308

Contact FSIGA:

• Telephone Number: (850) 222-1882 or visit their website at https://fsiga.org