To become a member of LAWCX, an entity must be a public agency which is permitted to self-insure for workers’ compensation coverage in the State of California. Each member of LAWCX must commit to participate in LAWCX for a minimum of three full program years. Please note that for prospective members wishing to apply directly to LAWCX, there is a $1,000 application fee that is payable upon submission of the application. If a prospective member joins LAWCX, the application fee is credited back.
If you are interested in joining LAWCX, please complete a prospective new member application. You can access the application by clicking here:
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The prospective new member must fully complete the LAWCX prospective new member application, Form A, and data requirements. Copies of the following documents must be attached with your completed application:
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Loss History reported per the requirements set forth in the Request for Detail Information – Electronic Data File Submission Workers’ Compensation Claims Information Specifications;
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Resolution Providing Coverage for Volunteers, if your entity has adopted such a resolution;
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Most Recent Claims Audit;
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Most Recent Financial Audit;
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Most Recent Workers’ Compensation Actuarial Study;
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“Modified Duty” Policy (if your entity has adopted one); and
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Agreement and Bylaws (if applicable).
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If the prospective entity has been accredited by the California Association of Joint Powers Authorities (CAJPA), some requirements of the application may be waived. These requirements have been noted with an asterisk (*) on the application form.
Following receipt of the application, the LAWCX Manager will review the application to ensure all information has been provided. The application and underwriting information will then be submitted to the LAWCX Underwriting Committee and Board of Directors for evaluation.
If the prospective member is applying directly to LAWCX, the Board of Directors must approve the member prior to binding coverage. If the prospective member is applying as an underlyng member through an existing member JPA, the prospective member must be approved for membership by the Underwriting Committee prior to binding coverage.
After the prospective member has been evaluated and approved for membership, the LAWCX Manager will bind the required coverage. If necessary, the new member’s contribution will be pro-rated from the date of binding of coverage to the end of the program year (June 30th).
Submit the completed application with all requested documentation to the attention of Ms. Karen Thesing, Manager, at:
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Bickmore Risk Services
1750 Creekside Oaks Drive, Suite 200
Sacramento, CA 95833
Phone: (800) 541-4591, ext. 1181 or (916) 244-1181
Fax: (916) 244-1199
E-mail: administrator@lawcx.org