Forms

This survey for LWCC policyholders evaluates current safety processes and operations and provides a starting point for development of a formal safety program. Sign up here to receive the survey.

LWCC closely follows the state statute that governs how policyholders can request to change their Agent of Record. Included are important steps to follow to make this process easy for everyone involved.

If you have any questions, comments, or general inquiries for LWCC, you can let us know here. A member of our Agency Relations team will get back to you as soon as possible.

Need to get in touch with our Safety Services team or request access to safety resources? Fill out the form and provide as many details as possible regarding your request, and we’ll get back to you as soon as possible.

If you would like to report someone who you think may be committing workers' compensation fraud, complete the information in this Fraud Reporting Form.

Injured workers need to complete a variety of forms throughout the claims process. Access the most up to date forms here.

As an injured worker, Louisiana law gives you the right to choose your own doctor, in any field or specialty of medicine, for necessary medical treatment and care.

Employees injured while engaged in maritime employment upon the navigable waters of the United States require the completion of Form LS-202. Timeliness is especially important with longshore reporting.

When a worker is injured on the job, a First Report of Injury must be completed. The First Report of Injury provides necessary information needed to begin the claims process.

Ownership is a valuable piece to the Experience Modifier calculation. Make sure LWCC and NCCI have up-to-date information on the ownership of the entities your clients have insured.

In order to receive access to LWCC’s password-protected website, agents must complete the registration form and await a verification email to complete the enrollment process.

Our free password-protected online platform simplifies the management of your workers’ comp insurance with LWCC. No access? Get enrolled in LWCC Interactive now.

Audit disputes are only accepted by submitting a completed Audit Dispute Form with supporting documentation. Having a standard form makes the audit dispute process more efficient.

The Employee Certificate of Compliance (Form LWC-WC-2025.EE) is a legal form released by the Louisiana Workforce Commission - a government authority operating within Louisiana. Injured workers are statutorily required to fill out this form and return to their Claims rep for Lost Time Claims.

LWCC policyholders can utilize safety videos free of charge through our Safety Video Lending Library program. Hundreds of safety titles are available in both Streaming and DVD format and in multiple languages. Register once and enjoy unlimited views of up to 5 selected titles per month.

In the event of a workplace injury that requires medication, completing this form can assist in providing the injured eligible prescriptions for first-fill at no cost of their own.