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Workers' comp insurance provides benefits to employees who are injured or become ill during the course of or due to employment. In California, every employer is required to carry insurance to cover the cost of occupational injuries and illnesses. This insurance requirement is mandatory even if you have only one part-time employee. Companies based out-of-state with employees hired in California must also have California workers' compensation insurance. Non compliance with California state workers' comp laws can result in serious penalties and fines.

 

DO NOT BE FOOLED!! We have people calling us who are looking for workers comp AFTER THEY HAVE BEEN FINED $1000s!!

 

IMPORTANT WORKERS COMP FAQs (READ THESE)

Assembly bill 279 states that business owners who intentionally operate without workers compensation in California are subject to possible prison sentence and up to a $10,000 fine

We are pleased to offer most of the major workers compensation insurers in California. We can help you if you have no claims, many claims, or even no workers comp coverage at all. The rates you receive will be some of the most competitive in the state. We also have markets for certain types of U.S. L & H risks.

We offer many California State Admitted Workers Compensation insurance carriers, allowing us to shop the best rates available for your company.

 

Please complete our information request form and one of our brokers will contact you soon.

 

General Information

 

Name of Business:

Contact Name:

Address:

City:

   State: CA   Zip:

Business Status:

     Other:

Business Tax ID Number:

Business Phone:

   Fax:

Best Time To Call:

Contact Email Address:

Years in Business 

How many Employees? 

Safety program in force?

Are you presently insured?

Name Of Current Insurer:

Current Annual Premium:

Policy Period:

TO

Short description of business operations:

Do employees perform work at heights above 15 Feet?  

What is your company's experience mod factor?

Please tell us some information about any claims listed above.

 

Please input your company's employee class codes (i.e.. Clerical is 8810), and the annual payroll in each class, and we MUST have the rate for each class. 

Please enter the standard California Workers Comp Class Codes and           Payroll info below:

Class Codes 

Annual Payroll for Class

Current Rate for Class 

 

IMPORTANT NOTE: This workers compensation form is provided as a convenience to you. We will make a good faith effort to obtain competitive quotes for your review. Depending on the type of business, we may require more information and will contact you if necessary. Your submission of this form DOES NOT guarantee that any binding workers compensation coverage offers will be forthcoming from insurers we represent. Also, in no way does submission of this form obligate anyone to any contract.

 

 

 

Insurance Guys®

is a registered trademark of

InsuranceGuys Insurance Services, Inc.
California License# 0B53906 / Arizona License# 137235

P.O. Box 6823  ~  Santa Barbara, CA 93160-6823

Office Toll Free: (800) 585-8887    Fax: (866) 585-8887

info@insuranceguys.com

 

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