Service Company Application Checklist

SERVICE COMPANY APPLICATION CHECKLIST. This form outlines the submission requirements for companies seeking approval to operate as service providers under the Louisiana Workforce Commission (LWC) Office of Workers’ Compensation. Applicants must include a $200 application fee payable to the Office of Workers’ Compensation and submit a fully completed, signed, and notarized Service Company Application (LWC-WC-2007). Each submission must include detailed resumes of personnel qualified in claims adjusting, safety engineering or loss control, and underwriting, with proof of at least one full-time employee who has two or more years of experience processing Louisiana workers’ compensation claims. Resumes must list previous employers and experience durations. Applicants must also provide background information on the company, such as brochures or pamphlets, and a sample service contract describing all services offered to self-insured clients. Once approved, service companies must promptly report ownership or personnel changes and submit a $200 annual reapplication fee to maintain active status. www.FormsWorkflow.com