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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 and is not currently a member through a existing member JPA, the Board of Direcotrs must approve the member prior to binding coverage. If the prospective member is applying as a direct member of LAWCX, but is currently a member of LAWCX 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
Sacramento Office
1750 Creekside Oaks Drive, Suite 200, Sacramento, CA 95833
Toll Free: (800) 541-4591, ext. 1181
Phone: (916) 244-1181; Fax: (916) 244-1199
E-mail: info@lawcx.org