Self-Insured Workers' Compensation Employers Eligibility and Application Instructions 

Pursuant to NRS 616B.300, an employer may qualify and remain qualified as a self-insured employer for workers’ compensation if the employer:

• Has a tangible net worth of $2,500,000, and
• Establishes a security deposit, based upon claims history and not less than $100,000, and
• Provides evidence of excess insurance to provide protection against catastrophic loss, and
• Establishes claims administration

Download the Initial Requirements for a Self-Insured Employer. (NRS 616B.300) 

An application must include:

1. Self-Insured Application Form 
2. Filing Fee: $200 (Non-refundable) The $200 filing fee is payable by check, money order or electronic funds transfer to the Nevada Division of Insurance; please contact ifn@doi.nv.gov for the Incoming Funds Notification form which must be submitted for electronic funds transfers. 
3. Three (3) years of audited financial statements
4. Three (3) years of loss runs
5. Proposed start date for self-insured status
6. Proposed claims administrator
7. Once the above requirements are met, the following will be required:
• Security deposit
• Evidence of excess insurance
• Insolvency assessment (0.5% of security deposit)

Applications and fee payment should be submitted to:

Nevada Division of Insurance
1818 East College Pkwy., Ste. 103
Carson City, NV 89706