# Title 45 — Insurance, Commissioner of

## Article 45-05 — Property and Casualty Insurance

## Chapter 45-05-01 — Self-Insurance Used as Security Required by the North Dakota Auto Accident Reparations Act

Reparations Act
### § 45-05-01-01. Definitions.

As used in this chapter:
1. "Certificate of self-insurance" means the certificate issued by the commissioner authorizing a
person to be a self-insurer.
2. "Commissioner" means the insurance commissioner of North Dakota.
3. "Person" or "persons" means any individual, partnership, corporation, or other legal entity who
are owners of one or more motor vehicles operated in North Dakota by them or with their
permission.
4. "Security requirement" means the financial ability of a person to make payment of basic
no-fault benefits of thirty thousand dollars per person per accident; motor vehicle liability
insurance of twenty-five thousand dollars per person, fifty thousand dollars per accident, and
twenty-five thousand dollars property damage; and uninsured motorist protection of
twenty-five thousand dollars per person and fifty thousand dollars per accident.
5. "Self-insurance" means any person who establishes a self-administered plan to meet the
security requirements as required by North Dakota Century Code chapter 26.1-41, the North
Dakota Auto Accident Reparations Act.
6. "Self-insurer" means a person who has an approved plan of self-insurance and holds a
certificate of self-insurance.
7. "Undertaking" means a continuing agreement by any person, or persons, or their duly
authorized officers and agents, to pay basic no-fault benefits and the liabilities covered by

motor vehicle liability insurance and to perform all other obligations imposed by North Dakota
Century Code chapter 26.1-41.
History: Amended effective January 1, 1987.
General Authority: NDCC 26.1-41-05(3)
Law Implemented: NDCC 26.1-41-01
### § 45-05-01-02. Self-insurers - Restrictions.

Only persons in whose name one or more motor vehicles are registered may qualify as
self-insurers. Such persons must file satisfactory evidence that they are possessed and will be
continued to be possessed of the ability to provide for the prompt and efficient administration of all
claims, benefits, and obligations provided by North Dakota Century Code chapter 26.1-41 and that
reliable financial arrangements, deposits, or commitments exist to meet their security requirement as
required by North Dakota Century Code chapter 26.1-41 substantially equivalent to those afforded by a
policy of insurance that would comply with that chapter.
General Authority: NDCC 26.1-41-05(3)
Law Implemented: NDCC 26.1-41-02(2)
### § 45-05-01-03. Evidence to be submitted by persons to obtain a certificate of self-insurance.

The commissioner will not issue a certificate of self-insurance until the person attempting to qualify
as a self-insurer shall have filed all of the following with the commissioner:
1. A completed application for a certificate of self-insurance (Appendix I).
2. An executed undertaking signed and sworn to by either the person or its president or
secretary or other similar officers (Appendix II).
General Authority: NDCC 26.1-41-05(3)
Law Implemented: NDCC 26.1-41-02(2)
### § 45-05-01-04. Issuance of certificate of self-insurance.

If a person files sufficient evidence to satisfy the commissioner that the person is qualified to be a
self-insurer under North Dakota Century Code chapter 26.1-41, the commissioner will issue a certificate
of self-insurance to that person. The certificate of self-insurance shall authorize any person to be a
self-insurer under North Dakota Century Code chapter 26.1-41 until that certificate is canceled by the
commissioner, or the commissioner's successors in office.
General Authority: NDCC 26.1-41-05(3)
Law Implemented: NDCC 26.1-41-02(2)
### § 45-05-01-05. Requirement of deposit.

The commissioner may require persons seeking to qualify as self-insurers, or persons qualified as
self-insurers in order to maintain their certificate of self-insurance, to make and maintain such deposits
or bond as the commissioner may require to assure that those persons will meet their security
requirements and all other obligations imposed by North Dakota Century Code chapter 26.1-41.
General Authority: NDCC 26.1-41-05(3)
Law Implemented: NDCC 26.1-41-02(2)
### § 45-05-01-06. Filing of annual statement.

As a condition to the continuance of a certificate of self-insurance, every self-insurer shall transmit
to the commissioner, not later than the first day of March in each year, a copy of its last annual

statement showing consolidated report and profit and loss statement as certified by a certified public
accountant or a reputable firm of public accountants. Any self-insurer who fails to comply with this
provision will have its certificate of self-insurance canceled.
General Authority: NDCC 26.1-41-05(3)
Law Implemented: NDCC 26.1-41-02(2)

(Article 45-05)
Insurance Commissioner
600 East Boulevard Avenue, Dept. 401
Bismarck, ND 58505
Date Application Received
The undersigned, herein referred to as the applicant, being the owner of one or more motor
vehicles, hereby makes application for a certificate of self-insurance. In connection with such
application the applicant makes the following declarations, for the purpose of enabling the insurance
commissioner to make a finding as to whether the applicant possesses the ability to handle and
process claims and make payments of basic no-fault benefits and the liabilities covered by motor
vehicle liability insurance as required by a self-insurer under North Dakota Century Code chapter
26.1-41, the North Dakota Auto Accident Reparations Act.
The applicant hereby agrees that if this application be approved, such approval shall be subject to
making and maintaining with the commissioner such deposits or bonds as the commissioner may
require.
It is further agreed and understood that the commissioner may cancel at any time the applicant's
certificate of self-insurance.
Name of Applicant ________________ Nature of Business ________________
Address (Principal Office) __________________________________________
_______________________________________________________________
1. Are you now operating as a self-insurer? ____________________________
If so, how long? ________________________________________________
2. Have you a claim department for investigating and adjusting claims?
_____________________________________________________________
If not, how are claims investigated and adjusted? _____________________
______________________________________________________________
3. Have you set up a reserve fund for accident claims? ____________________
If so, (a) Under what caption does it appear on your financial statement?
______________________________________________________________
and (b) What basis is used for determining reserve requirements?
______________________________________________________________
If not, how do you determine your outstanding liability?
______________________________________________________________
______________________________________________________________

4. Give the following information concerning accidents in which your vehicles were involved during
the past three years.
Accident Years
20____ 20____ 20____
A. Number of accidents:
Personal injury
Property damage
Total
B. Number of claims:
Settled by payment
Settled without payment
Open and pending
Total
Settled by payment
Settled without payment
Open and pending
Total
Number of accidents for which no
claims were made
C. Payments on claims:
Personal injury
Property damage
Total
D. Reserves for pending claims:
Personal injury
Property damage
Total
5. Are any automobile liability judgments open and unsatisfied? ______________
If so, how many? ___________ Total amount involved $__________________
Are any other judgments open and unsatisfied? ________________________
If so, how many? __________ Total amount involved $___________________
6. Is your company a self-insurer under any other phase of your business?
______________________________________________________________
If so, give particulars _____________________________________________
7. Describe motor vehicles owned by applicant (in North Dakota) under the following headings:

Year of Manufacture Make Vehicle Type Model License Number

An Individual
A Copartnership
A Corporation
Submitted by __________________________________________________
With principal offices at ___________________________________________
Condition at close of business ___________________________, 20_______
Dollars Cents
(1) Cash (a) On hand $
(b) In banks $
(2) Accounts receivable (a) Current $
(b) Slow $
(c) Past due $
(3) Notes receivable (a) Due within 30 days $
(b) Due after 90 days $
(c) Past due $
(4) Inventories (a) Finished goods $
(b) Work in process $
(c) Other $
(5) Other current assets (attach list) $
(6) Fixed assets Land $
Buildings
Less reserves $
Equipment
Less reserves $
Other

Less reserves $
Total $
(7) Other assets (attach list) $
Total Assets $
(1) Accounts payable trade (a) Not past due $
(b) Past due $
(2) Notes payable trade (a) To banks $
(b) To others $
(3) Accounts payable others (attach list) $
(4) Notes payable others (attach list) $
(5) Other liabilities (attach list) $
(6) Other reserves (attach list) $
Total liabilities $
(7) Capital stock paid in (a) Common $
(b) Preferred $
(8) If individual (or other), amount of investment $
(9) Surplus, earned $___________ (Paid in or other) $
Total net worth $
Total liabilities and net worth $
A. Contingent liabilities
(1) Liability on notes discounted, or sold, accounts
pledged or sold, or as guarantor on contracts or
other contingent liabilities.
Total contingent liabilities (attach schedule)
$
In lieu of filling in the financial statement above, applicants may attach a copy of their last annual
statement showing consolidated report and profit and loss statement as certified by certified public
accountant or a reputable firm of public accountants. Said statement to be a part of this application.
Give following additional information:

A. Names and addresses of banks in which company has accounts.
B. Insurance on:
Inventories ________________
Plants ____________________
C. Attach statement of profit and loss to date of balance sheet.
D. When and where incorporated or established
E. Are any assets pledged to secure notes, loans or mortgages payable?
F. If you have any notes or accounts receivable or payable from or to officers or
stockholders, give details concerning method and terms of payment.
G. List names of officers or partners of company.
H. If foreign entity, or nonresident individual, list agent for service of process.
Witness our hands and seals this _______ day of _____________, 20_____, at
______________________.
(Official Title) _____________
(Official Title) _____________
Before me, ______________________________, a notary public in and for said county and state,
personally appeared ______________________________, respectively of the above-named

(corporation), (partnership), or (proprietorship), and severally acknowledged the execution of the
foregoing and swore to the contents thereof this ________________ day of
______________________________, 20______.
Notary Public
My commission expires
___________________.
Financial ability Date
approved
Chief Examiner
Application approved Date
Insurance Commissioner

(Article 45-05)
The undersigned, pursuant to North Dakota Century Code chapter 26.1-41, the North Dakota Auto
Accident Reparations Act, being the owner of one or more motor vehicles as a condition to the
issuance of a certificate of self-insurance, hereby executes this undertaking and agrees as follows:
1. The undersigned will respond in the payment of the minimum security requirements as
provided under North Dakota Century Code chapter 26.1-41.
2. The undersigned will promptly and efficiently administer all claims made by injured persons, or
their successors, and make payment of no-fault benefits to them resulting from accidental
bodily injuries sustained in motor vehicles owned by the undersigned.
3. The undersigned agrees and understands that North Dakota Century Code chapter 26.1-41
imposes an absolute liability at law for payment of basic no-fault benefits as a result of being
the owner of motor vehicles.
4. The undersigned agrees that the undersigned and any other person occupying the
undersigned's motor vehicle or motor vehicles with the expressed or implied permission of the
undersigned shall be insured against loss from the liability imposed by law for damages
arising out of the operation of such motor vehicles within the United States of America, its
territories or possessions, or Canada, with respect to each such motor vehicle as follows:
twenty-five thousand dollars because of bodily injury to or death of one person in any one
accident and subject to said limit for one person, fifty thousand dollars because of bodily injury
to or death of two or more persons in any one accident, and ten thousand dollars because of
injuries to or destruction of property of others in any one accident; and coverage for the
protection of such persons who are legally entitled to recover damages from owners or
operators of uninsured motor vehicles and hit and run motor vehicles because of bodily injury,
sickness or disease, including death, resulting therefrom, in the amount of twenty-five
thousand dollars because of bodily injury to or death of one person in any one accident and
subject to said limit for one person, fifty thousand dollars because of bodily injury to or death
of two or more persons in any one accident.
5. The undersigned will promptly and efficiently administer and make a good-faith disposal of all
no-fault benefits, liability, and uninsured motorist claims.
6. The undersigned will perform all other obligations not specifically mentioned herein imposed
on a basic no-fault insurer by North Dakota Century Code chapter 26.1-41.
7. That any breach of this undertaking, or of the conditions imposed by North Dakota Century
Code chapter 26.1-41, will result in the cancellation of the undersigned's certificate of
self-insurance.
8. This undertaking shall bind not only the undersigned, but the undersigned's successors,
survivors, assigns, and legal representatives.
Witness our hands and seals this _____________ day of __________________, 20___, at
______________________________________.
(Official
Title)

(Official
Title)
Before me, _____________________________________, a notary public in and for said county
and state, personally appeared _________________________________, respectively, of the
above-named (corporation), (partnership), or (proprietorship), and severally acknowledged the
execution of the foregoing and swore to the contents thereof this ___________________________ day
of __________________________, 20____.
Notary Public
My commission expires ___________________.
Undertaking approved Dat
e
Chief Examiner
Undertaking approved Dat
e
Insurance Commissioner
History: Amended effective October 1, 1984.
