2019 South Dakota Codified Laws
Title 58 - Insurance
Chapter 20 - Workers' Compensation Insurance
§ 58-20-27 Application for self-insurance association--Form.
58-20-27. Application for self-insurance association--Form. An association proposing to self-insure its workers' compensation liability shall apply to the department for the authority to self-insure, using forms available from the department. The application shall include:
(1) The association's name;
(2) The location and mailing address of the association's principal office and where its books and records are kept;
(3) The name and address of each member of the association;
(4) A copy of the bylaws or plan of operation adopted by the association;
(5) Proof of compliance with § 58-20-28;
(6) A sample copy of the agreement between the association and the members securing the payment of each member's workers' compensation liability;
(7) A pro forma financial statement, on a form acceptable to the department, showing the financial ability of the association to pay the workers' compensation liability of its members; and
(8) The required application fee.
Source: SL 1995, ch 282, § 3.
