Official Form 109 Application for Self-insurance - Utah

What Is Official Form 109?

This is a legal form that was released by the Utah Labor Commission - a government authority operating within Utah. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 109?
A: Form 109 is an Application for Self-insurance.

Q: What is self-insurance?
A: Self-insurance is a method whereby an individual or organization assumes the financial risk for potential losses instead of obtaining insurance.

Q: Who should use Form 109?
A: Individuals or organizations seeking self-insurance in the state of Utah should use Form 109.

Q: What information is needed to complete Form 109?
A: Form 109 requires detailed information about the individual or organization applying for self-insurance, including financial information and supporting documentation.

Q: Are there any fees associated with Form 109?
A: Yes, there is a non-refundable administrative fee required when submitting Form 109.

Q: How should Form 109 be submitted?
A: Form 109 should be submitted by mail to the Utah Department of Insurance.

Q: Are there any deadlines for submitting Form 109?
A: Yes, Form 109 must be submitted on or before the due date specified by the Utah Department of Insurance.

Q: What happens after submitting Form 109?
A: After submitting Form 109, the Utah Department of Insurance will review the application and notify the applicant of their decision.

Q: Can I appeal a denial of self-insurance?
A: Yes, you can appeal a denial of self-insurance by following the procedures outlined by the Utah Department of Insurance.