1. Forms
  2. WC
  3. WC-00-00-01

What it does

The Information Page (WC 00 00 01 A, original printing issued May 1, 1988) personalizes the WC 00 00 00 policy. NCCI's Information Page Notes say the sequence of Items 1 through 4 may not be changed (except Item 3.D.), though carriers may rearrange the layout and use headings such as Insured, Policy Period, Coverage and Premium.

  • Item 1: exact name of each insured employer and its legal entity (individual, partnership, corporation, other), mailing address, other workplaces, and the FEIN for each entity. The notes also require the Interstate/Intrastate Risk Identification number.
  • Item 2: effective and expiration date and hour.
  • Item 3.A.: states whose compensation law Part One applies to. 3.B.: employers liability limits for bodily injury by accident (each accident) and by disease (policy limit and each employee). 3.C.: other states for Part Three. 3.D.: endorsements and schedules.
  • Item 4: classifications by state with code, estimated remuneration, rate per $100 and estimated premium, plus experience modification, schedule rating where filed, premium discount, minimum premium and expense constant.

Key rules agents should know

  • Item 3.C. may not list a 3.A. state or a monopolistic state. NCCI's suggested wording is "All states except North Dakota, Ohio, Washington, Wyoming, states designated in Item 3.A." plus any others the carrier excludes.
  • If the experience modification is not available at issue, the carrier says so in Item 4 and attaches WC 00 04 03, then endorses the final factor later.
  • For policies written in the assigned risk market, the bureau copy is marked "AR" or "WCIP".
  • Pennsylvania, New Jersey, New York and Wisconsin have their own information page instructions in their state manuals, and California uses its own information page (WC 04 00 01).

Quoting and selling notes

Most audit disputes start here. Check that every legal entity, DBA and FEIN is in Item 1, that each state with known operations is in 3.A., that 3.C. is broad enough for travel and new jobs, and that the employers liability limits match what the umbrella and the insured's contracts require. Class codes and payroll splits in Item 4 should reflect actual duties, because Part Five lets the insurer reassign classifications and rates by endorsement and final premium is set at audit. Mid-term changes to any item are made with WC 89 06 00 B.

Related forms

Policy WC 00 00 00; information page change WC 89 06 00; experience modification WC 00 04 03 and WC 00 04 25; premium discount WC 00 04 06.