Self-Insured Description:

Use of Self-Insurers’ Data in Experience Rating

The experience data of self-insured employers may be included in an experience rating upon written request to the Rating Services Division. The data must be submitted on a signed ERM – 6 form providing specific payroll and loss information, and the operations that produced the self-insurance experience are expected to be insured under a standard Workers Compensation and Employers Liability Policy. See “Forms” section to download a copy of the ERM – 6 form. There is a charge for each experience rating requested. See “Products” section for a schedule of charges for this service.


Please contact Philip Louie at extension 182 for additional information.

Reference: Please refer to the New York Experience Rating Plan Manual.