Arizona Self-Insurance Workers' Compensation Guaranty Bond

Arizona Self-Insurance Workers' Compensation Guaranty Bond

As part of its mission to safeguard the health and welfare of the State’s workforce, the Industrial Commission of Arizona (ICA) allows large employers who meet certain criteria to self-insure for their workers’ compensation coverage, provided they obtain a surety bond. The Self Insurance Workers’ Compensation Guaranty Bond assures the ICA that employers will pay all outstanding workers’ compensation claims, regardless of the financial state of the employer.

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Jet has taken the surety bond application process and removed all of the red tape and inefficiency, making it faster and easier to purchase your Workers’ Compensation Bond.

What Is the Bond Limit and Cost of the Self-Insurance Workers’ Compensation Bond Cost?

The Self-Insurance Workers’ Compensation Bond must be in an amount that is 125% of the unpaid workers’ compensation losses, with a minimum of $100,000. The calculation for the bond limit can be found on the Workers’ Compensation Liability Form.

With Jet, the Workers’ Compensation bond costs just a small percentage of the bond limit. Once you complete the application, providing information about your business, the Jet team will quickly get back to you with a quote and option to pay for your bond.

Jet cuts out the middlemen who add on to the cost of your bond with their commissions and fees. That means that Jet gets you the bond you need at a low rate, and with options for annual or monthly payments that work for every business.

What Is the Purpose of the Arizona Self-Insurance Workers’ Compensation Bond?

The Self-Insurance Workers’ Compensation Bond is one method of financial assurance required by the ICA that a company that opts to self-insure for workers’ compensation will pay their employees for legitimate claims. Even in the unfortunate event of the bankruptcy of the employer, workers are guaranteed compensation for injuries that occurred in the line of work by Jet through the bond.

The bond or other financial assurance is set by the Industrial Commission of Arizona as a long-standing labor institution charged with the mission of protecting the “life, health, safety, and welfare of Arizona’s workforce.” Specifically with respect to self-insurance, the commission works to ensure that employers that are participants in the self-insurance program uphold their commitment to their employees, paying (and securing the means to pay) all legitimate workers’ compensation claims.

How Does the Application Process Work With Jet?

At Jet, we streamlined the application process to make buying your bond simple, so you can get back to your business ASAP. Once you complete your bond application online and provide some business information (i.e. business financial statements), we will review and quickly get back to you with a quote for your bond and a way to purchase.

After you have paid for the bond, Jet will immediately begin filing the bond for you with ICA, with an electronic copy emailed to you for your records.

Can Jet File the Workers’ Compensation Bond for Me?

Yes, Jet can! Once your purchase is complete, Jet will ship the signed and sealed bond to the ICA for you. A copy will be mailed to you, with an electronic copy available immediately. If you wish to ship the bond directly to the ICA yourself in addition to the ICA’s Initial Application for Authority to Self-Insure, that option will be made available to you at checkout. 

All paperwork must be sent to the address below:

Industrial Commission of Arizona
800 W Washington Street
Phoenix, AZ 85007

Can I Cancel My Self-Insurance Workers’ Compensation Bond and Get a Refund?

Yes, you can cancel your Workers’ Compensation Bond with Jet. Once Jet receives a written request to cancel the bond, Jet will send notice to the ICA, which will hold the bond in effect for an additional 60 days. Until that 60-day period has ended, the bond remains active, and Jet will continue to draw monthly payments (if on a monthly payment plan) or account for this time against the refund for annual or multi-year terms. Once cancellation is finalized, Jet will calculate the remaining time on the bond for a refund. 

Under the terms of the bond, self-insured employers need to secure another bond or other form of deposit if they wish to retain the authority to self-insure for their workers’ compensation. Without it, their authority to self-insure will be revoked by the ICA.

How Do I Renew the Self-Insurance Workers’ Compensation Bond?

Renewing your Self-Insurance Workers’ Compensation Bond is easy with Jet’s monthly payments — as long as payment continues to be made successfully, your bond will stay in force. If you are on annual or multi-year payments, you will receive notice well before the renewal deadline of your bond. 

Any changes to your bond limit can be addressed at the time of renewal to ensure that you will hold appropriate coverage for the new licensure term. Each year, the ICA will request a copy of signed, internally-reviewed financial statements to renew the employer’s authority to self-insure. The statements must be mailed at least 30 days prior to the employer’s anniversary of self-insurance to allow for the ICA’s evaluation of whether the bond limit is sufficient for the renewal term.

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How Does an Employer Avoid Self-Insured Workers’ Compensation Bond Claims?

Under the Arizona Revised Statutes Section 23-966, self-insured employers can avoid claims against their Workers’ Compensation Bond by paying their employees’ initial claims honorably and reliably. If they do not, the ICA may investigate the viability of unpaid workers’ compensation claims, incurring expenses for third-party experts or consultants, travel, and legal fees in the process. Those administrative expenses, along with the underlying unpaid compensation claims could result in a claim by the ICA against the Workers’ Compensation Bond.

What Happens if I Get a Self-Insured Workers’ Compensation Bond Claim?

Notify Jet right away if you receive notice of a pending claim against your Self-Insured Workers’ Compensation Bond. Jet will work diligently to defend against false claims. All pertinent documentation and communication relative to the case will be reviewed from you and the claimant. 

If the claim is deemed valid, Jet Insurance Company is obligated to pay the amount claimed within 45 days, up to the limit of the bond amount. Consider Jet to be your financial guarantor in this case, paying the claim raised by the ICA on your behalf. However, you remain responsible for the actions (or inaction) that resulted in the claim and will be required to reimburse Jet for this payment. Failure to do so would severely jeopardize the ability to obtain future surety bonds, and may result in the forfeiture of the authority to self-insure.

Arizona Self-Insurance Workers' Compensation Guaranty Bond Form

Notary Bond Application:

X

Business Information:

Indemnity Agreement:

I, the undersigned, hereby apply for a Dishonesty Bond also known as a Business Service Bond or Janitorial Service Bond (“bond”) to the Surety Company (“SURETY”) through Jet Insurance Company (“JET”), with whom I hereby grant the authority to act on my behalf with respect to the bond and assign as my Broker of Record, and declare that the statements herein are true and correct. In consideration of the SURETY issuing, renewing or substituting said bond(s), I, individually and as the owner or officer of the bonded entity, hereby understand and agree, as follows: (i) to reimburse, hold harmless, and indemnify SURETY upon demand for all loss, liability, claim, expense, including but not limited to attorneys’ fees, expert’s fees, investigative fees and claims handling fees, and any other cost which SURETY shall pay or incur in defense, adjustment, or settlement of such claims/suits by reason of such suretyship; (ii) that an itemized statement of loss and expenses by SURETY shall be indisputable proof of my liability to SURETY; (iii) coverage is subject to a $100 deductible; (iv) the employee must be convicted before coverage will apply (v) performance and any form of dispute resolution of this agreement shall take place in the county of SURETY's office of service; and (vi) a facsimile copy or electronically signed version of this agreement shall be binding as if it were an original. This agreement shall survive any changes in, substitute to or renewal of the bond(s).

Required Effect Date of Bond Policy:

Contact Information:

Employee Dishonesty Bond Application:

Business Information:

Business Description:

Coverage Requirements:

Indemnity Agreement:

I, the undersigned, hereby apply for a Dishonesty Bond also known as a Business Service Bond or Janitorial Service Bond (“bond”) to the Surety Company (“SURETY”) through Jet Insurance Company (“JET”), with whom I hereby grant the authority to act on my behalf with respect to the bond and assign as my Broker of Record, and declare that the statements herein are true and correct. In consideration of the SURETY issuing, renewing or substituting said bond(s), I, individually and as the owner or officer of the bonded entity, hereby understand and agree, as follows: (i) to reimburse, hold harmless, and indemnify SURETY upon demand for all loss, liability, claim, expense, including but not limited to attorneys’ fees, expert’s fees, investigative fees and claims handling fees, and any other cost which SURETY shall pay or incur in defense, adjustment, or settlement of such claims/suits by reason of such suretyship; (ii) that an itemized statement of loss and expenses by SURETY shall be indisputable proof of my liability to SURETY; (iii) coverage is subject to a $100 deductible; (iv) the employee must be convicted before coverage will apply (v) performance and any form of dispute resolution of this agreement shall take place in the county of SURETY's office of service; and (vi) a facsimile copy or electronically signed version of this agreement shall be binding as if it were an original. This agreement shall survive any changes in, substitute to or renewal of the bond(s).

Required Effect Date of Bond Policy:

Contact Information:

Contract Bond Application:

X

Business Information:

Owner Information:

Job Details:

Indemnity Agreement:

I, the undersigned, hereby apply for a Dishonesty Bond also known as a Business Service Bond or Janitorial Service Bond (“bond”) to the Surety Company (“SURETY”) through Jet Insurance Company (“JET”), with whom I hereby grant the authority to act on my behalf with respect to the bond and assign as my Broker of Record, and declare that the statements herein are true and correct. In consideration of the SURETY issuing, renewing or substituting said bond(s), I, individually and as the owner or officer of the bonded entity, hereby understand and agree, as follows: (i) to reimburse, hold harmless, and indemnify SURETY upon demand for all loss, liability, claim, expense, including but not limited to attorneys’ fees, expert’s fees, investigative fees and claims handling fees, and any other cost which SURETY shall pay or incur in defense, adjustment, or settlement of such claims/suits by reason of such suretyship; (ii) that an itemized statement of loss and expenses by SURETY shall be indisputable proof of my liability to SURETY; (iii) coverage is subject to a $100 deductible; (iv) the employee must be convicted before coverage will apply (v) performance and any form of dispute resolution of this agreement shall take place in the county of SURETY's office of service; and (vi) a facsimile copy or electronically signed version of this agreement shall be binding as if it were an original. This agreement shall survive any changes in, substitute to or renewal of the bond(s).

Required Effect Date of Bond Policy:

Contact Information:

Worker's Compensation Application:

X

Business Information:

Business Description:

Coverage Requirements

Indemnity Agreement:

I, the undersigned, hereby apply for a Dishonesty Bond also known as a Business Service Bond or Janitorial Service Bond (“bond”) to the Surety Company (“SURETY”) through Jet Insurance Company (“JET”), with whom I hereby grant the authority to act on my behalf with respect to the bond and assign as my Broker of Record, and declare that the statements herein are true and correct. In consideration of the SURETY issuing, renewing or substituting said bond(s), I, individually and as the owner or officer of the bonded entity, hereby understand and agree, as follows: (i) to reimburse, hold harmless, and indemnify SURETY upon demand for all loss, liability, claim, expense, including but not limited to attorneys’ fees, expert’s fees, investigative fees and claims handling fees, and any other cost which SURETY shall pay or incur in defense, adjustment, or settlement of such claims/suits by reason of such suretyship; (ii) that an itemized statement of loss and expenses by SURETY shall be indisputable proof of my liability to SURETY; (iii) coverage is subject to a $100 deductible; (iv) the employee must be convicted before coverage will apply (v) performance and any form of dispute resolution of this agreement shall take place in the county of SURETY's office of service; and (vi) a facsimile copy or electronically signed version of this agreement shall be binding as if it were an original. This agreement shall survive any changes in, substitute to or renewal of the bond(s).

Required Effect Date of Bond Policy:

Contact Information: