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Instruction outstanding death 2026
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- Click ‘Get Form’ to open the instruction outstanding death document in the editor.
- Begin by listing all outstanding self-insured death claims on Form SI-4. Ensure that each claim is valued as of September 30, 2016, and organized in descending order based on the date of accident.
- Group claims by accident year, starting with the most recent (April 1, 2015 - March 31, 2016) and moving backward. Claims prior to April 1, 2008 should be categorized under an 'all prior years' group.
- For Form SI-4.1, include totals for disability and medical reserves on each page. Make sure to total these reserves for each accident year at the end of the respective section.
- If any claims have been adjusted by the Self-Insurance Office, ensure they are reserved according to those adjustments. Include all workers’ compensation accidents entitled to benefits while excluding medical treatment-only cases.
- Affirm and sign Forms SI-4 and SI-4.1 by an authorized officer of your organization. If additional pages are necessary, only complete the affirmation on the top page.
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| 2016 | 4.8 Satisfied (65 Votes) |
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