SELF INSURANCE TRUST PROGRAM

Questions for a Trust Manager

1. What is the number of participants in the Trust?

2. Please provide the names of all members of the Board of Directors.

3. Does the Trust send a financial statement to the participants each year? 

4. Do the participants sign all Trust documents?

5. Does the Trust carry Employer’s Liability Coverage? If so:
A) What Insurance Company?
B) What limits?
C) What retention?
D) How is the retention, if any, paid? By the Trust or by participant?

6. Does the Trust carry excess insurance?
A) Specific? If so, answers to 2 A, B, C and D above are needed.
B) Aggregate? If so, answers to 2 A, B, C, and D above are needed.

7. The Trust has been in existence since (indicate year). What has past history been as respects:
A) Dividend?
B) Loss Ratio?

8. Please provide an audited financial statement that includes:
A) The annual premium in the Trust
B) The Trust’s unencumbered surplus
C) The Trust’s claims reserve, including IBNR
D) The Trust’s reserves for the New York State Assessment

9. What payment plans does the Trust offer to the participants?

10. A) Please describe the Trust’s procedures for withdrawal or termination of a participant.
B) What are the requirements for a member to notify the Trust that it is withdrawing?
C) What are the penalties for withdrawal and termination?
D) How does withdrawal or termination affect the participant’s eligibility for future dividends?
E) What information, if any, does the Trust provide to the New York Compensation Insurance Rating Board with regard to the participant.

11. Does the Trust pay commission to the agent?

12. Does the New York Workers’ Compensation Board consider the Trust to be adequately funded? If not, is the Trust subject to any membership or rate restrictions?

13. Please provide the names of the firms that fill the following roles for the Trust:
A) Certified Public Accountant
B) Actuary
C) Third Party Administrator
D) Auditor

14. Is a bond or letter of credit required from participants?

15. How are Experience Modifiers calculated for participants?

Special Thanks to Dave Twomey, Bob Menikheim, & Charlie Reller for this list.