Claim Summary Addendum for 2023 Annual Survey


This excel document is for Individual Private Self-Insurers to report their cumulative claims data statistics by year, to include corresponding payroll, number of locations and number of employees. All claims data (closed and open) are required.


Instructions for Completion of Claims Summary Addendum
This document contains the instructions for the completion of the Claims Summary Addendum report of workers’ compensation claims and outstanding liabilities as part of the Self-Insurance Annual Survey.