Form SI-21 Certificate of Excess Insurance Contract for Self-insurer - New York

What Is Form SI-21?

This is a legal form that was released by the New York State Workers' Compensation Board - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form SI-21?
A: Form SI-21 is the Certificate of Excess Insurance Contract for Self-insurer in the state of New York.

Q: Who needs to complete Form SI-21?
A: Self-insurers in New York who have obtained excess insurance coverage need to complete Form SI-21.

Q: What is a self-insurer?
A: A self-insurer is an entity that assumes the financial risk of its own losses instead of purchasing insurance from a traditional insurance carrier.

Q: What is excess insurance?
A: Excess insurance is a type of insurance that provides coverage for losses that exceed the underlying primary insurance policy.

Q: Why do self-insurers need to complete Form SI-21?
A: Self-insurers need to complete Form SI-21 to certify that they have obtained excess insurance coverage to supplement their self-insurance program.

Q: How should I complete Form SI-21?
A: You should carefully fill out all the required information on Form SI-21, including your self-insurer identification number, excess insurance policy information, and signatures.

Q: When should Form SI-21 be submitted?
A: Form SI-21 should be submitted annually, along with the required fee, before the expiration date of the current excess insurance policy.

Q: What are the consequences of not completing Form SI-21?
A: Failure to complete and submit Form SI-21 in a timely manner may result in the suspension or revocation of your self-insurance status in New York.