This Workers' Compensation Insurance Online Submission process will walk the insurer through each field required by CSLB. This process was established to provide Insurance Companies with a way to submit Worker's Compensation policy information in real time.
Upon submission, this information will be directly input into CSLB's database (with the exception of a future effective date (within 30 days), these will be placed in a holding pattern and updated on the policy effective date).
You cannot use Online Submission if the insured is a leasing company or if this is a cancellation. Please continue to submit these with the required addendums by mail.
DO NOT use this form if you are the licensed contractor or applicant. Online Submission is ONLY to be completed by an insurer duly licensed to write worker's compensation insurance in this state (Business Professions Code 7125 (a)) or an authorized agent or employee of the insurer.
Be sure to use the "Back" and "Next" buttons at the bottom of each page - DO NOT use your browser's back arrow because all of your entered information will be erased and you will have to start over.
Please type your information directly into the fields of this form. If you copy text from another application or document and paste it into this easy-fill form and the text contains invalid (non-ASCII) characters, they will be removed from the final document.
Make sure you give yourself enough time to complete the entire form in one sitting. You will not be able to save a partially filled form to complete at a later time.