Self-Insured Employer Workers Comp: What It Means and Who Handles Your Claim

October 17, 2025

Table of Contents

Estimated reading time: 12 minutes

Key Takeaways

When an employer is self-insured, the employer—not an insurance carrier—funds workers’ compensation benefits and often hires a third-party administrator (TPA) to handle day-to-day claims.
To learn who handles your claim, ask HR, check the posted coverage notice, and contact the California Division of Workers’ Compensation (DWC) if you’re still unsure.
The difference between self-insured and state fund programs shows up in who pays, who administers the claim, and how disputes are resolved—your appeal rights remain the same.
Large employers may use on-site clinics, return-to-work specialists, and dedicated TPAs, which can speed communication but add layers—document everything.
Excess insurance protects self-insured employers against catastrophic losses so injured workers’ benefits continue even with large claims.

When your employer is self‑insured, understanding self‑insured employer workers comp is critical to knowing who handles your claim, how medical care is approved, and how benefits are paid. Define self‑insured as: an employer arrangement where the employer assumes financial responsibility for workers’ compensation claims and pays benefits from company funds rather than purchasing a standard workers’ compensation insurance policy.

This guide explains what “self‑insured” actually means, who handles your claim, how the process differs from state fund or traditional insurance, California-specific steps and resources, a practical checklist, and a short case study. If you’re asking “who handles my workers comp claim,” you’ll find clear, step-by-step answers here.

What “self‑insured” actually means

In a self-insured employer workers comp program, the company—not a carrier—pays medical care, temporary disability, permanent disability, and other compensable benefits from its own resources. Many employers partner with a claims administrator, and regulators set standards to ensure injured workers receive benefits. A plain-language overview of the model is available in the Berry Insurance explainer on self-insured workers’ compensation and a legal perspective from KJT Law Group.

How self‑insurance works (employer pays claims vs. insurer)

Self‑insurance = employer funds medical care, temporary disability, permanent disability, and other compensable benefits from its own resources; employer may purchase excess insurance to protect against catastrophic losses. Most large programs buy “excess” coverage above a set retention (for example, $250,000) so a single severe injury does not threaten the company’s balance sheet; this arrangement helps ensure continued payment of benefits. You’ll see similar financial safeguards and oversight requirements in state materials, such as the New York Workers’ Compensation Board’s self‑insured guidance and the Washington State Department of Labor & Industries (L&I) self‑insurance overview. For a practical breakdown of how claims are paid and administered day to day, the Berry Insurance guide is helpful.

In many programs, a third‑party administrator (TPA) approves treatment, issues payments, and communicates with you, while the employer funds the claim. This is often called a “self‑insured employer workers comp” arrangement with TPA administration.

Why some employers choose self‑insurance (cost control, cash flow, return‑to‑work programs)

Cost control: Employers that avoid carrier premiums can lower overhead if claims are stable and predictably managed. Internal safety and claims practices can directly impact total costs.
Cash flow: Rather than fixed annual premiums, the employer pays actual claim costs as they arise—smoothing cash needs over time.
Program customization: Self‑insured programs can tailor return‑to‑work, safety, and vocational rehabilitation to the workforce, reducing long‑term costs and improving outcomes.
Faster handling: Dedicated internal teams or a contracted private workers comp provider (TPA) can respond quickly with authorizations and payments, as noted by both Berry Insurance and the employee‑focused perspective at 612 Injured.

States restrict self‑insurance to financially strong employers and require security (like deposits) and compliance audits—a principle echoed in the NY WCB self‑insured guidance and reinforced by Washington L&I’s self‑insurance program.

Who handles my workers comp claim when my employer is self‑insured

Typical parties — employer, claims administrator/TPA, private workers comp provider, on‑site HR/occupational health

Employer HR / Risk Management: Takes your initial report, completes internal incident forms, notifies the TPA, and coordinates return‑to‑work accommodations.
Third‑Party Administrator (TPA) / private workers comp provider: A company contracted to administer claims but not the payer of benefits. It investigates, assigns the claim number, authorizes medical care, and issues benefit payments on the employer’s behalf. Definitions and oversight models are described in Washington L&I’s self‑insurance materials, employee‑facing explanations at 612 Injured, and the KJT Law Group overview.
On‑site occupational health / clinic: Provides triage and early treatment, creating contemporaneous medical records that are useful for claim decisions.
State oversight (DWC / WCAB): Regulators audit programs and adjudicate disputes, ensuring compliance and protecting injured workers’ rights.

In short, a self‑insured employer funds benefits while a private workers comp provider (TPA) administers your claim. This structure is common in large companies and can result in quicker initial contact, but it also means you should carefully track who is doing what and when.

How to identify the claims handler (look at notice, employer HR, DWC contact info)

Use these steps to confirm who handles my workers comp claim and how to contact them:

Step 1: Ask HR the direct question: “Is our workers’ compensation coverage self‑insured? Who is the claims administrator?” Or use this expanded script: “Is our workers’ compensation coverage self‑insured? Who is the claims administrator and how do I contact them?”
Step 2: Check the posted workers’ compensation notice for TPA/claims administrator contact information; many workplaces post details and claim forms or provide them upon request. This is also emphasized by employee resources like 612 Injured.
Step 3: If uncertain, visit the California Division of Workers’ Compensation (DWC) website, review DWC forms & coverage resources, or contact the DWC Ombudsman for help confirming coverage and the claims handler.

If you’re new to the California process, this step pairs well with an overview of how to file a workers’ comp claim in California, including getting and submitting the DWC‑1 form in a timely way.

Example communications you should expect from the handler

Expect prompt, written details from the TPA or HR. Typical messages include:

Claim number: [XXXXXX]. Assigned adjuster: [Name], phone: [XXX‑XXX‑XXXX], email: [name@tpa.com].We have received your injury report and opened Claim #[XXXX]. Please schedule follow‑up medical care with [provider name] and send all bills/statements to [billing@tpa.com].You may be eligible for temporary disability benefits pending medical verification — the adjuster will provide details within 14 days.

We have received your injury report and opened Claim #[XXXX]. Assigned adjuster: [Name]. Please contact [phone/email] to schedule approved medical care.

If these details are missing or unclear, follow up with your HR contact and, if needed, seek guidance from the DWC Ombudsman.

The claims process comparison: difference between self‑insured and state fund

This section compares how reporting, medical care, payments, and disputes typically work when an employer is self‑insured versus when the state fund or a traditional insurer covers claims.

Initial reporting and investigation

Self‑insured: Report to your employer/HR. The employer and its TPA investigate; internal notes and records may speed early contact and approvals.
State fund/insurer: Report to your employer, who notifies the carrier. The insurer assigns an adjuster and follows standardized procedures (the state fund uses its own adjusters and processes).

Oversight and models of administration discussed here mirror features in the Washington L&I self‑insurance page and employee-facing guidance from 612 Injured.

Medical care and provider choice

In California, employees may predesignate a personal physician before an injury. Otherwise, employers can direct initial medical care to a company physician or authorized provider whether self‑insured or not. If you have a predesignation on file, ask HR to confirm and share it with the TPA; otherwise, follow the employer/TPA directions and document any variations. If you need forms or information, see DWC Forms & Information.

For a refresher on reporting, timelines, and form submission, this step pairs with our guide to applying for workers’ comp in California.

Payments, temporary disability, and settlement handling

Self‑insured: Payments are issued by the employer or the TPA on employer funds. Your check stubs or deposit remittance may show the employer or the administrator as payer.

State fund/insurer: Checks are issued by the insurer/state fund and documented in insurer records.

To verify the payer, follow this simple practice: check the remittance stub for payer name and contact; request written confirmation stating who issues payments and who approves medical bills. For settlement education, see our overview of workers’ comp settlements in California.

Dispute resolution and appeals (role of WCAB / state oversight)

In California, if benefits are denied or disputed, the process uses DWC resources and the Workers’ Compensation Appeals Board (WCAB) for petitions, hearings, and appeals. Self‑insured status does not remove appeal rights or change the tribunal. The DWC Ombudsman can explain steps and provide neutral assistance. This consistent path to adjudication applies regardless of the difference between self‑insured and state fund programs.

Quick summary (callout bullets)

Self‑Insured: Employer pays claims; may use a TPA/private provider; more local control; potentially faster communication; excess insurance often purchased.
State Fund: Employer pays premium; state/insurer pays claims; standardized procedures; reduced employer control.

For context on California’s public insurer, read about the State Compensation Insurance Fund.

Special considerations for a large company injury claim California

How large employers often structure claims (TPAs, on‑site clinics, vocational rehab programs)

In a large company injury claim California, expect a layered structure:

On‑site clinics/occupational health: Often provide first triage and contemporaneous documentation; they may be employer‑designated initial providers.
Dedicated claims teams: Internal case managers liaise with the TPA/private workers comp provider for authorizations, wage statements, and return‑to‑work notes.
Vocational rehab / return‑to‑work specialists: Large employers frequently deploy specialists to reduce lost‑time costs and identify transitional or modified duty roles.

California‑specific institutions/regulation to reference (list and links)

Practical advice for Californians (what to document, who to contact, typical timelines)

Document: Photos of the scene, witness names, date/time, written notes of events and symptoms.
Medical: Get immediate care. Ask the provider to document work‑related causation in the record.
Contacts: Capture claim number, adjuster name, TPA contact, and HR contact. Save emails and texts.
Timelines: Initial acceptance/denial often occurs within ~14 days (varies by case and jurisdiction)—a practical benchmark noted by 612 Injured. Always verify current guidance through DWC.

For broader process context, see our primer on how to report a workplace injury and what to expect next.

Private workers comp provider vs self‑insured employer — what’s the relationship?

When employers use a private workers comp provider or TPA to administer claims

Many self‑insured employers hire a private workers comp provider (TPA) to manage day‑to‑day claims tasks—intake, investigation, medical authorizations, bill payment, and communication—while the employer retains financial responsibility for benefits. This is common enough that employee resources like 612 Injured and regulatory pages such as Washington L&I’s self‑insurance overview address it directly. You may interact primarily with the TPA, but benefits are funded by your employer’s self‑insured program.

How responsibilities split: funding vs administration vs oversight

Employer (Funding): Pays claim costs, sets strategy, and maintains return‑to‑work obligations.
TPA/private provider (Administration): Runs day‑to‑day claims, medical management, and payment processing on the employer’s behalf.
State (Oversight): Regulates, audits, and provides dispute resolution through DWC/WCAB.

This division is distinct from the difference between self‑insured and state fund models, but the fundamentals of your rights and appeal paths remain the same.

Step‑by‑step checklist for injured workers with a self‑insured employer

Use this checklist immediately after an injury, and keep it updated through the life of the claim.

Immediate actions

Report the injury to your supervisor and HR immediately. Sample script: “I want to report a work‑related injury that occurred on [date/time]. Please document it and tell me the next steps.”
Get medical care now—use the on‑site clinic or emergency care if needed.
Take photos and gather witness names and contact information.
Fill out and retain copies of any employer incident or claim forms (DWC‑1, if provided).
If you’re unsure who handles my workers comp claim in a self‑insured setting, ask HR and request the TPA’s contact details in writing.

Within days

Confirm the claims handler. Get your claim number, adjuster name, and TPA contact. Request written confirmation of who is issuing payments.
Obtain copies of all reports and medical records; keep copies of any forms you signed.
Log all communications (date, time, name, topic, and any promises made).
If a private workers comp provider administers the claim, record the mailing address and email for bills, notes, and work status reports.

Ongoing

Track appointments, bills, and work‑status notes. Send copies to the claims handler and keep originals.
Maintain a wage log if you miss work; note dates, hours, and any partial shifts.
Keep a weekly symptom journal to support medical documentation.
Continue to update your contact log for the adjuster, HR, and providers.

If you hit a dispute

Escalate in stages: contact the DWC Ombudsman → request a conference/mediation → file with the WCAB if still unresolved.
Consider legal counsel if you face persistent denials, complex causation issues, or suspected bad faith. For a starting point on representation, see our guide to choosing a workers’ comp lawyer in California.
Remember: the difference between self‑insured and state fund arrangements doesn’t change your core right to appeal disputes.

For timing tips, this complements our overview of the 90‑Day Rule and key deadlines.

Real‑life example / short case study

Case Study: Large Company Injury Claim California

Jane works for a major California employer that is self‑insured for workers’ compensation. She slips in the break room and injures her knee.

Day 0: Reports injury to her supervisor and HR, visits the on‑site nurse, and completes the incident report. She asks HR who will handle the claim.
Day 1: Receives an email from the TPA with a claim number and adjuster contact. She saves the message and adds the TPA details to her contact log.
Day 2–5: The TPA reviews initial records and authorizes an MRI at an approved clinic. Jane forwards work‑status notes and saves receipts.
Day 10: The TPA sends temporary disability payment information. Jane confirms the payer on the remittance and requests written confirmation of who issues checks.
Day 20: A dispute arises over the scope of physical therapy. Jane contacts the DWC Ombudsman for guidance and keeps a record of all calls and emails.
Day 30: A WCAB conference is scheduled. After discussions, the employer agrees to cover extended therapy and clarify future authorizations.

What went well: Jane documented early; asked “who handles my workers comp claim”; got her claim number fast; saved every email and work‑status note; and confirmed the payer in writing.

Friction points: Authorizations for therapy required escalation; clarifying payer/approvals took persistence; timely communication logs made the difference.

For settlement basics should her claim later resolve, Jane reviews our overview of workers’ comp settlements explained.

Resources & next steps

To deepen your understanding of self-insured employer workers comp and the difference between self‑insured and state fund programs, start here:

Conclusion

Whether your employer is self‑insured or covered by the state fund, the essentials are the same: report quickly, confirm the claims handler, document everything, and use California’s DWC/WCAB framework to resolve disputes. The biggest changes with self‑insurance are who pays and who administers your file—usually a TPA or private workers comp provider working on the employer’s behalf. With the resources and steps above, you can navigate confidently and keep your recovery on track.

Need help now? Get a free and instant case evaluation by Visionary Law Group. See if your case qualifies within 30-seconds at https://eval.visionarylawgroup.com/work-comp.

FAQ

Who handles my workers comp claim?

If your employer is self‑insured, a TPA/private workers comp provider or HR/risk management typically administers the claim while the employer funds benefits. Confirm by asking HR, reviewing the posted notice, and contacting the California DWC if needed.

Can I choose my doctor?

In California, you may predesignate a personal physician before an injury. If you haven’t, initial care can be directed to an employer‑designated provider. Review and use DWC forms and information, and ask HR to confirm any predesignation on file.

Is my employer’s self‑insurance safe?

States require financial strength, deposits, and audits for self‑insured programs. Many employers also buy excess insurance to cover catastrophic claims. See the NY WCB self‑insured requirements and Washington L&I self‑insurance overview for examples of safeguards.

What if my employer denies the claim?

You can pursue California’s dispute path through DWC/WCAB. The DWC Ombudsman offers neutral guidance, and you can file with the WCAB to request hearings and appeals.

How long before I get benefits?

Initial acceptance or denial often occurs within about 14 days, though timing varies by case and jurisdiction; see the practical benchmark discussed by 612 Injured, and always confirm current guidance with DWC.

Self-Insured Employer Workers Comp: What It Means and Who Handles Your Claim