Below, you can gain easy access to all necessary forms and publications, all with just a few clicks. And remember, we have designed this site to be a resource center for both agents and policyholders , but if you need help beyond the scope of this site, do not hesitate to contact us directly.


AGENT FORMS AND PUBLICATIONS
  • Standard ACORD Application
  • Producer Agreement
  • Indemnity Agreement
  • Rejection of Coverage
  • Wage Designation
  • Work Experience
  • Construction Supplemental Questionnaire
  • Trucking Supplemental Questionnaire
  • No Loss Statement
  • Underwriting Guidelines
  • FAQs from Agents
  • Fund Overview for Agents
  • Brief Fund History
  • Marketing Brochure
  • Who We Are Brochure
AUDIT FORMS AND PUBLICATIONS
  • Premium Audit Brochure
  • Self-Reporting Audit
  • State Quarterly Unemployment Forms
  • Federal Quarterly 941 Forms
  • Federal 1099 Forms
MEMBER INSURED FORMS AND PUBLICATIONS
  • Second Injury Fund Brochure
  • Accident Investigation
  • Application for Employment
  • Second Injury Fund Questionnaire Revised 2009
  • WC First Report of Injury
  • Claims Brochure
  • BENEFITS OF LC&I
  • ABOUT LC&I
  • WORKSHOPS
  • TRUSTEES
  • STAFF
  • SMALL BUSINESS & RESOURCES
  • FORMS & PUBLICATIONS
  • SAFETY & IMPORTANT LINKS
  • CONTACT

LC&I | Louisiana Construction & Industry Self Insurers Fund | 1130 West Causeway Approach • Mandeville, LA 70471 | Phone: (985) 612-1230 | Fax: (985) 612-1240