Request an Application for Workers' Compensation Insurance
To apply for workers' compensation insurance with State Fund, you must complete and submit the required application forms. You may obtain these forms via:
The application forms include:
- ACORD™ Application
- Supplemental Application Form
- Field Inspection
- Audit Advisory
- Independent Contractor Questionnaire
All forms must be completely filled out and signed. Please note that any shaded areas on the forms should be left blank. You may mail your completed application forms to your local State Fund District Office. Our District Offices are open Monday - Friday, 8:00 a.m. - 5:00 p.m.
Should you need insurance immediately, you may bring the completed forms and your five-year policy history, if applicable, to a State Fund office by 3 p.m. for expedited consideration. This does not guarantee same-day coverage.
Additional information may be necessary on some risks.
A certificate of insurance may be issued the day your policy becomes effective if the deposit is paid with a cashier’s check. If your deposit is paid with a personal/business check, a certificate of insurance will be issued when your check clears your bank.
If you have any questions regarding the application forms, please contact our Customer Service Center.
Thank you for your interest in State Fund. We look forward to serving your workers’ compensation needs.
Note: 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.
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