MENU Interested Agency Form The Interested Agency Form is a multi-step form that consists of seven steps. Please take the time to completely fill out the form in order for LUBA Workers' Comp to receive your information successfully. You will be required to enter/upload the following information in order to complete this form Agency information Brief history of the agency (file upload) Key personnel (file upload) BEGIN THE FORM News & MediaFind a ProviderPrivacy PolicySign InReport a ClaimResourcesContact © 2021 LUBA Workers’ Comp

MENU Reset Password Please enter your Client Id and User Id below, click the submit button, and an email will be sent to you with a new password. If it does not arrive in your inbox immediately, please check your spam folders. Don't know your client ID or user ID? If you do not know your Client ID or User ID, you may request them by emailing cicenter@lubawc.com or you may contact our Sales department at (888) 884-5822 for assistance. Don't have an active account? If you do not have an active Client ID and User ID, you may request one here. Client ID * User ID * RESET PASSWORD News & MediaFind a ProviderPrivacy PolicySign InReport a ClaimResourcesContact © 2021 LUBA Workers’ Comp

MENU LUBA Policyholders GO TO LUBA CONNECT Policyholders SERVICES WORKPLACE SAFETY SAFETY RESOURCES SAFETY VIDEOS LOSS CONTROL CONSULTATION PAYMENT OPTIONS PREMIUM AUDITS TOOLS & DOCUMENTS FAQ Find a Provider Report a Claim Report Fraud Your Account As a valued policyholder, making sure you and your employees are safe at work is our mission. Through workplace safety initiatives and a free loss control consultation from our expert team, we want to provide you valuable resources and the support you need should an injury occur. Interested in becoming a LUBA Policyholder? LUBA offers workers’ comp coverage in Louisiana, Mississippi, Texas, and Arkansas through local independent agencies. If you are interested in receiving a quote from LUBA, contact our sales department to be referred to an agency in your area. Report Claim Go to LUBA Connect Find a Provider News & MediaFind a ProviderPrivacy PolicySign InReport a ClaimResourcesContact © 2021 LUBA Workers’ Comp

MENU Request an Account First Name * Last Name * Email Address * Are you requesting access as an Agent or Policyholder? * Agent Policyholder Agency Name Agency Location/City Company Name (for Policyholder requests only) Policy Number (for Policyholder requests only) REQUEST ACCOUNT News & MediaFind a ProviderPrivacy PolicySign InReport a ClaimResourcesContact © 2021 LUBA Workers’ Comp