WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY AVAILABLE ENDORSEMENTS AND THEIR USES

(December 2020)

INTRODUCTION

The National Council on Compensation Insurance, Inc. (NCCI) has developed and filed two types of endorsements in the states where it has jurisdiction. Standard endorsements can be modified only as NCCI permits. On the other hand, advisory endorsements are only advisory and may be used or modified almost any way the insurance company believes necessary, subject to making proper filings with the state authority that has jurisdiction.

ENDORSMENTS NUMBERING SCHEME

Workers Compensation and Employers Liability endorsements are numbered in a specific format that designates the type of endorsement, the way it is used, the version or edition, and the state where it applies. The number starts with WC and is then followed by three separate two-digit sequences and possibly a letter.

The first two digits establish wherever the form is nationwide or applies to a specific state. If 00 is used, the form is a countrywide form. If any of the numbers below are used, the endorsement is a state specific form.

State	Code	State	Code	State	Code
Alabama	01	Kentucky	16	North Dakota	33
Alaska	54	Louisiana	17	Ohio	34
Arizona	02	Maine	18	Oklahoma	35
Arkansas	03	Maryland	19	Oregon	36
California	04	Massachusetts	20	Pennsylvania	37
Colorado	05	Michigan	21	Rhode Island	38
Connecticut	06	Minnesota	22	South Carolina	39
Delaware	07	Mississippi	23	South Dakota	40
Dist. of Columbia	08	Missouri	24	Tennessee	41
Florida	09	Montana	25	Texas	42
Georgia	10	Nebraska	26	Utah	43
Hawaii	52	Nevada	27	Vermont	44
Idaho	11	New Hampshire	28	Virginia	45
Illinois	12	New Jersey	29	Washington	46
Indiana	13	New Mexico	30	West Virginia	47
Iowa	14	New York	31	Wisconsin	48
Kansas	15	North Carolina	32	Wyoming	49

The numbers 89 are for miscellaneous endorsements, and 99 is reserved for proprietary forms of a specific insurance company.

The second two-digit sequence identifies the type of endorsement. They are:

01–Federal Coverages and Exclusions
02–Maritime Coverages and Exclusions
03–Other Coverages and Exclusions
04–Premium
05–Retrospective Premium
06–Miscellaneous Endorsements

The third 2-digit sequence is the individual sequence number of the endorsement. It differentiates that specific endorsement from other endorsements of the same type, in the same state, or within the same series.

The final alpha character identifies the version or a later edition of the endorsement. If there is no alphabetical character at the end, the endorsement is the only version or edition ever produced. The letter “A” indicates the first revision, "B" the second, and so forth.

Example: WC 00 02 01 B is the second edition of a workers compensation countrywide federal endorsement.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY ENDORSEMENTS

Note: This analysis addresses only countrywide endorsements.

FEDERAL COVERAGE ENDORSEMENTS

WC 00 01 01 A–Defense Base Act Coverage Endorsement

The Defense Base Act extends the United States Longshore and Harbor Workers' Compensation Act (USL&HWCA) to apply to contractors that perform work at overseas military bases. The bases may be in a United States territory or possession or may be in a foreign country. The USL&HSCA is also extended to apply to various public works contracts being performed outside the continental United States but only if listed and described on the endorsement schedule. This endorsement provides the required coverage.

MARITIME COVERAGE ENDORSEMENTS

WC 00 02 01 B–Maritime Coverage Endorsement (01 15 change)

This endorsement provides Jones Act required coverage for maritime operations.

Exclusion 14 in the endorsement is amended to clarify that even when premium is paid to remove this exclusion that punitive damages related to this exclusion continue not to be covered.

WC 00 02 03–Voluntary Compensation Maritime Coverage Endorsement

This endorsement can be used only if WC 00 02 01 A–Maritime Coverage Endorsement is also used. This endorsement changes the Jones Act coverage from negligence based to a Workers Compensation Coverage base basis using the listed state’s workers compensation law as its base of coverage.

WC 00 02 04–Limited Maritime Coverage Endorsement

This is only an advisory endorsement. Part Two Employers Liability Insurance C. Exclusion 10 excludes bodily injury to a vessel's master and crewmembers. This endorsement deletes that exclusion with respect to the listed code numbers and classification phraseology listed on the endorsement schedule. This endorsement can be used when non-maritime type employees have a connection with the vessel. Some examples are trades people or caterers.

OTHER COVERAGE AND EXCLUSION ENDORSEMENTS

WC 00 03 01 A–Alternate Employer Endorsement

This endorsement is used to protect a client from being considered a statutory employer for the named insured’s employees while those employees work on the client’s premises and/or under the client’s direction.

Related Article: Alternate Employer Endorsement

WC 00 03 02–Designated Workplaces Exclusion Endorsement

This endorsement excludes coverage for work or at workplaces listed in the space provided on the endorsement schedule. It may be used when a wrap-up program provides workers compensation coverage for a particular job. The named insured can eliminate all payroll associated with that workplace.

WC 00 03 03 C–Employers Liability Coverage Endorsement

This endorsement eliminates all workers compensation coverage for any state listed on the endorsement schedule. This results in coverage being provided for only employers liability. It can be used as a way to provide employers liability coverage in monopolistic states or to provide only employers liability coverage when all employees are exempt from mandatory workers compensation coverage.

Workers Compensation Monopolistic State Funds

Stop Gap–Employers Liability Coverage

WC 00 03 04–Insurance Company as Insured Endorsement

This endorsement is used when the named insured is an insurance company that provides workers compensation insurance or reinsurance. It removes coverage for any obligation that named insured has to other insured’s workers compensation losses.

WC 00 03 05–Joint Venture as Insured Endorsement

This endorsement adds members of a joint venture as insureds. Coverage applies only with respect to the member's capacity as the employer of the joint venture's employees.

WC 00 03 06–Medical Benefits Exclusion Endorsement

This endorsement is used if the named insured is a qualified self insurer of medical benefits. It excludes all coverage for medical benefits required by the workers compensation law of any state listed on the endorsement schedule under Part One–Workers Compensation Insurance.

WC 00 03 07–Medical Benefits Reimbursement Endorsement

This endorsement is used if the insurance company and the named insured agree that the named insured pays for all medical payments that the workers compensation law requires. It is used only when the state does not consider the named insured to be a qualified self-insurer.

WC 00 03 08–Partners, Officers, and Others Exclusion Endorsement

This endorsement is used to exclude specific individuals or groups of individuals from workers compensation and employers liability coverage. However, each state dictates the ability to use this endorsement. State law provides guidance on who can and who cannot refuse coverage. When used, it must be done very carefully because the named insured may be responsible for significant costs for which there is no insurance.

WC 00 03 09 B–Rural Utilities Service Endorsement

This endorsement is used if the named insured is a rural electrification cooperative and if the Rural Electrification Agency (R.E.A.) requires it. It specifies that the named insured will submit the policy, endorsements, and forms to the R.E.A. before it goes into effect and that the R.E.A. will be notified at least ten days prior to the effective date of cancellation if coverage is cancelled. It also has conditions that address tort liability and immunity with respect to adjusting claims, defending suits, and other legal actions.

WC 00 03 10–Sole Proprietors, Partners, Officers, and Others Coverage Endorsement

This endorsement is the opposite of WC 00 03 08 because it adds coverage for individuals who are usually exempt from coverage. Individuals may be specifically named or may be identified as groups, such as all partners or all executive officers (except the president). The remuneration for each individual added must be added to the premium basis.

WC 00 03 11 A–Voluntary Compensation and Employers Liability Coverage Endorsement

This endorsement adds Voluntary Compensation coverage to the policy.

Related Article: Voluntary Compensation Insurance

WC 00 03 12 A–Voluntary Compensation and Employers Liability Coverage for Residence Employees Endorsement

This endorsement provides Voluntary Compensation coverage and Employers Liability coverage but for only domestic workers. It can be added to a workers compensation policy or to homeowners' policies, comprehensive personal liability policies, or any other policy that provides similar personal liability coverage. It is used when coverage for such workers is not mandatory.

WC 00 03 13–Waiver of Our Right to Recover from Others Endorsement

This endorsement is used to waive the insurance company's rights of subrogation against named third parties that are listed on the endorsement schedule that may be held responsible for an injury.

WC 00 03 14 A–Workers Compensation and Employers Liability Coverage for Residence Employees Endorsement

This endorsement is used to provide the statutory workers compensation obligations of an insured employer of domestic workers. It is designed to be added to homeowners' policies, comprehensive personal liability policies, or any other policy that provides similar personal liability coverage.

WC 00 03 15–Domestic and Agricultural Workers Exclusion Endorsement

This endorsement is used to exclude all coverage for farm or agricultural workers and/or for domestic or household workers. Individuals may be specifically listed or be described on the endorsement schedule, such as all farm or agricultural workers and employees or all domestic or household workers. It can be used in only states whose law allows using it.

WC 00 03 19–Employee Leasing Client Endorsement

This endorsement is used to allow an employee-leasing firm to not report payroll for employees leased to others under contract. Information regarding the contract must be entered on the schedule, and the client must prove they have obtained the necessary coverage and have certificates of insurance to prove it.

WC 00 03 20 B–Professional Employer Organization (PEO) Extension Endorsement

This endorsement is added to the policy of a client who leases employees from a PEO. The client agrees to provide the mandatory workers compensation coverage for the employees it leases from the PEO but only for those supplied under the designated contract and in the listed state(s) on the endorsement schedule.

WC 00 03 21 A–Professional Employer Organization (PEO) Exclusion Endorsement

This endorsement excludes coverage for workers the named insured leases to specific clients. The policy this endorsement is part of does not cover workers the named insured leases to any client listed on the endorsement schedule or others added after the policy is issued, even if they are not actually endorsed to the policy. Changes that involve such information must be reported to the insurance company immediately.

WC 00 03 22 A–Professional Employer Organization (PEO) Client Exclusion Endorsement

This endorsement excludes leased workers from the named insured's policy and covers only its direct employees. A policy with this endorsement does not cover any workers leased from the PEO listed on the endorsement schedule and any PEO used after the policy’s inception date, even if not endorsed.

WC 00 03 23 A–Multiple Coordinated Policy Endorsement

This endorsement is used on policies issued to clients of a Professional Employer Organization (PEO) to provide coverage for workers leased from that PEO on a multiple coordinated policy basis. Coverage does not apply to any other workers, whether leased or not. A separate policy must be issued to each client company to cover all other employees.

WC 00 03 24–Workers Compensation Insurance Plan–Other States Endorsement

This endorsement is attached to all policies written under the Workers Compensation Insurance Plan (WCIP) (also known as the Assigned Risk Plan). It amends A. 3. and A. 4. under Part Three–Other States Insurance. Under A. 3, the insurance company reimburses the named insured for benefits that the workers compensation law of that state requires meaning that there is no direct payment to the injured employee. Under A. 4, if the named insured has work on the effective date of this policy in any state listed under Item 3.C. of the Information Page, coverage is not provided for the state unless the insurance company is notified within 30 days.

WC 00 03 25–Residual Market Multiple Company Endorsement

This endorsement is used when affiliated companies are providing residual market workers compensation and employers liability coverage in states other than the primary location state. Each state listed under Item 3.A. of the Information Page is entered under Schedule A and the insurance company that provides coverage in that state is entered in Schedule B.

WC 00 03 26 A–Residual Market Limited Other States Insurance Endorsement

This endorsement is used on policies written in the residual market. It deletes Part Three–Other States Insurance in the policy. It then adds back a more restricted version of Part Three.

PREMIUM ENDORSEMENTS

WC 00 04 01 A–Aircraft Premium Endorsement

This endorsement states the additional premium required for each aircraft listed on the endorsement schedule for Classification Code 7421–Aviation–Transportation of Personnel in Conduct of Employer's Business–Flying Crew. Passenger seat surcharges are made separately.

WC 00 04 02–Anniversary Rating Date Endorsement

This endorsement states the Normal Anniversary Rating Date (NARD) when it is different than the policy effective date.

Related Article: Anniversary Rating Date Endorsement

WC 00 04 03–Experience Rating Modification Factor Endorsement

This endorsement is used when the named insured's experience rating modification factor is not available when the policy is issued. The insurance company endorses the policy to reflect the correct factor when it is determined.

WC 00 04 04–Pending Rate Change Endorsement

This endorsement is used if the rates on the policy when it is issued may be changed because of a pending rate change filing by the regulatory authority that has jurisdiction. If the pending rate filing results in different rates than the ones used on the policy, the insurance company endorses the new rates and the effective date of change. It is used if there is only one state under Item 3. A. on the Information Page. If there is more than one state, this endorsement applies to only the state(s) listed on the endorsement schedule.

WC 00 04 05–Policy Period Endorsement

This endorsement is used if the policy period is more than one year and sixteen days and does not consist of complete twelve-month periods.

WC 00 04 06 A–Premium Discount Endorsement

This endorsement states how the Premium Discount rules in the Basic Manual of Workers Compensation and Employers Liability Insurance apply.

Related Article: Premium Discount Endorsement

WC 00 04 07–Rate Change Endorsement

This endorsement is used when a rate change occurs after the policy was issued. The date of the change and the state it affects must be entered on the endorsement schedule. If the increase applies to all classifications in the state, that percentage is entered. However, the change for each code must be entered if the rate change varies by classification.

WC 00 04 08–Longshore and Harbor Workers' Compensation Act Rate Change Endorsement

This endorsement is used when a rate change that affects the Longshore and Harbor Workers’ Act classifications occurs after the policy was issued. The date of the change and the state it affects must be entered on the endorsement schedule. If the increase applies to all classifications in the state, that percentage is entered. However, when the change is specific to a classification, each code to which it applies must be listed.

WC 00 04 09–Premium Determination Endorsement–Former Self-Insurers 1

This is an assigned risk endorsement. It must be attached if the employer was self insured within 12 months of applying for this coverage. It is not used if the employer is a self-rated risk as determined by the applicable workers compensation insurance rating organization's filed experience rating plan, on policies subject to retrospective rating, or for more than three consecutive years for the same employer.

WC 00 04 10–Premium Determination Endorsement–Former Self-Insurers 2

This is an assigned risk endorsement. It is similar to WC 00 04 09 but is different because it states that the premium does not include an "insurance charge."

WC 00 04 11–Assigned Risk Premium Differential Endorsement

This is an assigned risk endorsement. It is used when the named insured has work in more than one state. It states the rate and premium for the states listed on the endorsement schedule.

WC 00 04 12–Contingent Experience Rating Modification Factor Endorsement

This endorsement is used on policies subject to an experience rating modification factor. The factor on the endorsement schedule is a Contingent Experience Rating Modification Factor based on available experience data and replaces any previous experience modification factor. The insurance company issues an endorsement that states the revised factor when and if the required additional experience data becomes available. The contingent factor applies until and unless a revised factor is subsequently issued.

WC 00 04 13–Assigned Risk Premium Surcharge Endorsement

This endorsement applies a residual market surcharge based on the entire standard premium according to the state rate pages that apply.

WC 00 04 14–Notification of Change in Ownership Endorsement

This mandatory endorsement is used on all policies to inform the named insured that ownership changes as detailed in the endorsement must be reported to the insurance company within 90 days after the change takes place.

WC 00 04 15 B–Assigned Risk Adjustment Program Endorsement

This endorsement integrates additional provisions under Part Five–Premium because one or more states listed under Item 3. A. on the Information Page approved the Assigned Risk Adjustment Program (ARAP). ARAP surcharges the premiums of assigned risk employers that meet its criteria.

WC 00 04 17 B–Assigned Risk Loss Sensitive Rating Plan Notification Endorsement

This endorsement is used with every assigned risk policy. The Loss Sensitive Rating Plan (LSRP) is a mandatory program for risks in the assigned risk market that meet the eligibility threshold. It details eligibility criteria, deposit/initial premium and LSRP contingency deposit, effect of changes in LSRP standard premium, and penalties for evading LSRP. It applies to states listed on the endorsement schedule.

WC 00 04 18 F–Assigned Risk Loss Sensitive Rating Plan Endorsement

This endorsement is added to Part Five–Premium and explains how the Assigned Risk Loss Sensitive Rating Plan (LSRP) premium is calculated.

WC 00 04 19–Premium Due Date Endorsement

This mandatory endorsement makes the Workers Compensation and Employers Liability Insurance Policy conditions comply with the National Association of Insurance Commissioners (NAIC) Statement of Statutory Accounting Principles No. 6. It adds the due date for audits and retrospectively rated policy premiums so that uncollected audit premiums are treated as an admitted asset.

WC 00 04 20–Terrorism Risk Insurance Act Endorsement

WC 00 04 21–Domestic Terrorism, Earthquakes and Catastrophic Industrial Accidents Premium Endorsement

WC 00 04 21 C–Catastrophe (Other than Certified Acts of Terrorism) Premium Endorsement

WC 00 04 22 A–Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement

WC 00 04 23–Assigned Risk Loss Sensitive Rating Plan Notification Endorsement for Professional Employer Organization (PEO) and Temporary Arrangements

This endorsement informs the named insured that it may become subject to the assigned risk mandatory Loss Sensitive Rating Plan (LSRP) during the term of the policy or its renewal, resulting in a change in its workers compensation policy cost. It must be added to assigned risk policies of any size in states that have approved the LSRP covering professional employer organizations (PEOs) and other organizations that offer similar temporary employment arrangements.

RETROSPECTIVE PREMIUM ENDORSEMENTS

WC 00 05 01–Retrospective Premium Endorsement–Rating Options I, II, III, or IV–One Year Plan

This endorsement is used for the Rating Options I, II, III, or IV of the Retrospective Rating Plan with a one-year rating plan period. This is used when a named insured is eligible to be under a Rating Options I, II, III, or IV retrospective rating plan and has elected to do so. The rating plan period is the one-year period beginning with this endorsement's effective date.

WC 00 05 02–Retrospective Premium Endorsement–Rating Options I, II, III, or IV–Three Year Plan

This endorsement is used for the Rating Options I, II, III, or IV of the Retrospective Rating Plan with a three-year rating plan period. This is used when a named insured is eligible to be under a Rating Options I, II, III, or IV retrospective rating plan and has elected to do so. The rating plan period is the three-year period beginning with this endorsement's effective date.

WC 00 05 03 C–Retrospective Rating Plan Premium Endorsement–One-Year Plan

This endorsement is used for a one-year rating plan period. This is used when a named insured is eligible to be under a retrospective rating plan and has elected to do so. The rating plan period is the one-year period beginning with this endorsement's effective date.

WC 00 05 04 C–Retrospective Rating Plan Premium Endorsement–Three-Year Plan

This endorsement is designed for a three-year rating plan period. This is used when a named insured is eligible to be under a retrospective rating plan and has elected to do so. The rating plan period is the three-year period beginning with this endorsement's effective date.

WC 00 05 05 C–Retrospective Rating Plan Premium Endorsement–Wrap-up Construction Project

This is used when a named insured‘s long term construction project is eligible to be under a retrospective rating plan and has elected to do so. The rating plan period is the length of the construction project on the Information Page and begins with this endorsement's effective date.

WC 00 05 08–Retrospective Premium Endorsement–Aviation Exclusion

This endorsement is used when an agreement is made that the aviation exposures of a risk are not subject to any retrospective rating plan. Any codes and classifications that apply are listed on the endorsement schedule.

WC 00 05 09–Retrospective Premium Endorsement–Changes

This endorsement is used when the Excess Loss Premium Factor, the Retrospective Development Factors or tax multiplier is changed.

WC 00 05 09 A–Retrospective Premium Endorsement–Changes

This endorsement is used to change the Excess Loss Premium Factor, the Retrospective Development Factors, the Tax Multiplier, and to list the states where the Retrospective Development Factor does not apply.

WC 00 05 10 A–Retrospective Rating Plan Premium Endorsement–Nonratable Catastrophe Element or Surcharge

This endorsement changes the standard premium and incurred losses portions of the retrospective rating plan premium endorsement attached to the policy to eliminate the nonratable catastrophe premium surcharge and also to eliminate certain catastrophic losses that may have incurred.

WC 00 05 11–Retrospective Premium Endorsement–Short Form

This endorsement is used if the named insured has more than one policy subject to the same retrospective rating option to identify the policy number that includes the applicable Retrospective Rating Plan Premium Endorsement.

WC 00 05 12 C–Retrospective Rating Plan Premium Endorsement–One-Year Plan–Multiple Lines (01 15 change)

This is similar to WC 00 05 03 C–Retrospective Rating Plan Premium Endorsement–One-Year Plan except that it includes multiple lines of business.

WC 00 05 13 C–Retrospective Rating Plan Premium Endorsement–Three-Year Plan–Multiple Lines

This endorsement is similar to WC 00 05 04 C–Retrospective Rating Plan Premium Endorsement–Three-Year Plan except that it includes multiple lines of business.

WC 00 05 14 C–Retrospective Rating Plan Premium Endorsement–Wrap-Up Construction Project–Multiple Lines

This endorsement is similar to WC 00 05 05 C–Retrospective Rating Plan Premium Endorsement–Wrap-up Construction Project except that it includes multiple lines of business.

WC 00 05 15 A–Retrospective Rating Plan Premium Endorsement–Flexibility Options

This endorsement changes the retrospective rating plan premium endorsement attached to the policy by permitting presenting thee options that can be selected by the insurance company and the named insured to modify the retrospective rating plan.

WC 00 05 16–Retrospective Rating Plan Premium Endorsement–Large Risk Alternative Rating Option (LRARO)

This endorsement applies only to workers compensation and employers liability coverage that has been rated under provisions of a negotiated Large Risk Alternative Rating Option (LRARO) and is subject to a retrospective rating plan.

MISCELLANEOUS ENDORSEMENTS

WC 00 06 03–Benefits Deductible Endorsement

This endorsement applies to only Part One–Workers Compensation Insurance. It lists the amounts and types of deductible selected that apply. The deductible applies separately to each claim for bodily injury by accident or disease unless a law requires payment on a per-accident or per-disease basis. In those cases, the deductible applies separately to each accident or disease, regardless of the number of persons who sustain injury by such accident or disease.