Complete the form below to request an application for workers' compensation insurance be sent to you by mail. Please note that this form is not an application for workers' compensation insurance coverage and that your submission of information does not constitute coverage. For your convenience, you may also download [212 k] the application forms. If you have any questions, please contact the Customer Service Center.
The State Compensation Insurance Fund is organized as a public enterprise fund and is a division within the California Department of Industrial Relations. The State Compensation Insurance Fund is not a branch of the State of California.
