1. Forms
  2. WC
  3. WC-00-03-01

What it does

WC 00 03 01 A (Ed. 2-89) applies to bodily injury to the named insured's employees while in the course of special or temporary employment by the alternate employer, in the state named in Item 2 of its Schedule. For those injuries, Part One (Workers Compensation) and Part Two (Employers Liability) apply as though the alternate employer were insured. If Item 3 names a contract or project, the coverage is limited to that work. NCCI's Item P-20 introduced the "A" version effective February 15, 1989; Texas switched from the original 4-84 edition to version A through NCCI Item 01-TX-2025.

Key provisions

  • The insurer reimburses the alternate employer for statutory benefits if it cannot pay them directly.
  • The endorsement does not satisfy the alternate employer's own duty to secure compensation, and the insurer will not file evidence of coverage for it with any agency.
  • The insurer will not ask the alternate employer's other insurers to share a covered loss, so this policy is primary for these injuries.
  • Premium is charged for the insured's employees while in special or temporary employment. The policy can be canceled without notice to the alternate employer.
  • The alternate employer must follow Part Four (duties after injury) and recognize the insurer's defense and inspection rights.

Who needs it

NCCI's instructions give three examples: a contractor required by an oil company to protect the company from claims by the contractor's employees; a property operator or manager required by the owner to protect the owner from the manager's employees; and a supplier of temporary office help protecting its customer. A staffing firm may schedule alternate employers as "all" or "any." The alternate employer's state must be an Item 3.A. state.

Quoting and selling notes

  • Read the contract: a request for "alternate employer" or "borrowed servant" protection is satisfied by this form, not by a certificate holder entry or a waiver of subrogation. When a contract asks for both protections, attach both this form and WC 00 03 13.
  • Collect the client list or confirm the blanket wording, and make sure each client state is in Item 3.A.
  • Some bureau states have their own versions, such as Minnesota's alternate employer endorsement excluding employers liability (WC 22 03 06) and North Carolina's WC 32 03 04.

Related forms

Waiver of subrogation WC 00 03 13; base policy WC 00 00 00.