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Workers Compensation and Employers Liability (NCCI WC)

40 forms available for WC

Condition

3 forms
Form CodeTitleLatest EditionStates
WC 00 04 1490-Day Reporting Requirement—Notification of Change in Ownership Endorsement01 19All States
WC 00 04 19Premium Due Date Endorsement01 01All States
WC 00 04 24Audit Noncompliance Charge Endorsement01 17All States

Coverage

1 forms
Form CodeTitleLatest EditionStates
WC 00 00 00Workers Compensation and Employers Liability Insurance Policy01 15All States

Declaration

1 forms
Form CodeTitleLatest EditionStates
WC 00 00 01Workers Compensation and Employers Liability Insurance Policy Information Page05 88All States

Endorsement

31 forms
Form CodeTitleLatest EditionStates
WC 00 01 01Defense Base Act Coverage Endorsement04 92All States
WC 00 01 02Federal Mine Safety and Health Act Coverage Endorsement01 15All States
WC 00 01 04Federal Employers' Liability Act Coverage Endorsement10 04All States
WC 00 01 06Longshore and Harbor Workers' Compensation Act Coverage Endorsement04 92All States
WC 00 01 08Nonappropriated Fund Instrumentalities Act Coverage Endorsement04 92All States
WC 00 01 09Outer Continental Shelf Lands Act Coverage Endorsement01 15All States
WC 00 01 11Migrant and Seasonal Agricultural Worker Protection Act Coverage Endorsement07 92All States
WC 00 01 16Notification Endorsement of Pending Law Change to Terrorism Risk Insurance Program Reauthorization Act of 201901 27All States
WC 00 02 01Maritime Coverage Endorsement01 15All States
WC 00 02 03Voluntary Compensation Maritime Coverage Endorsement04 84All States
WC 00 02 04Limited Maritime Coverage Endorsement06 92All States
WC 00 03 01Alternate Employer Endorsement02 89All States
WC 00 03 03Employers Liability Coverage Endorsement10 04All States
WC 00 03 05Joint Venture as Insured Endorsement04 84All States
WC 00 03 10Sole Proprietors, Partners, Officers and Others Coverage Endorsement04 84All States
WC 00 03 11Voluntary Compensation and Employers Liability Coverage Endorsement08 91All States
WC 00 03 13Waiver of Our Right to Recover From Others Endorsement04 84All States
WC 00 04 03Experience Rating Modification Factor Endorsement04 84All States
WC 00 04 04Pending Rate Change Endorsement04 84All States
WC 00 04 06Premium Discount Endorsement07 95All States
WC 00 04 12Contingent Experience Rating Modification Factor Endorsement01 90All States
WC 00 04 21Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement08 21All States
WC 00 04 22Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement01 21All States
WC 00 04 25Experience Rating Modification Factor Revision Endorsement05 17All States
WC 00 05 03Retrospective Rating Plan Premium Endorsement—One-Year Plan01 19All States
WC 00 06 03Benefits Deductible Endorsement02 91All States
WC 04 03 06Waiver of Our Right to Recover From Others Endorsement—CaliforniaN/ACA
WC 20 01 01Massachusetts Terrorism Risk Insurance Program Reauthorization Act Endorsement Withdrawn01 08MA
WC 31 03 08New York Limit of Liability Endorsement01 00NY
WC 31 03 23New York Construction Classification Premium Adjustment Program Explanatory Endorsement10 25NY
WC 42 03 04Texas Waiver of Our Right to Recover From Others EndorsementN/ATX

Exclusion

3 forms
Form CodeTitleLatest EditionStates
WC 00 03 02Designated Workplaces Exclusion Endorsement04 84All States
WC 00 03 08Partners, Officers and Others Exclusion Endorsement04 84All States
WC 00 03 15Domestic and Agricultural Workers Exclusion Endorsement04 84All States

Other

1 forms
Form CodeTitleLatest EditionStates
WC 89 06 00Policy Information Page Endorsement07 01All States