What it does
WC 00 03 03 C (Ed. 10-04) applies only to work in the states shown in its Schedule. In those states Part One (Workers Compensation) does not apply, and Part Two (Employers Liability) applies as though the states were listed in Item 3.A. It adds exclusion 13: no coverage for injury to an employee when the employer is deprived of common law defenses or is subject to a penalty because it failed to secure its compensation obligations in a scheduled state or otherwise failed to comply with that law.
Who needs it
- Monopolistic states: North Dakota, Ohio, Washington and Wyoming are monopolistic fund states, and NCCI's Information Page notes bar listing them in Item 3.C. A private policy cannot provide Part One there, so the carrier schedules those states on this endorsement to give Part Two employers liability, commonly called "stop gap."
- Other uses: the North Carolina bureau's instructions describe the form as providing employers liability where the policy does not provide compensation, and allow it only when all employees are excluded from, or have elected out of, the act and no law prohibits it.
Key provisions
- The Part Two limits on the Information Page apply.
- Exclusion 13 means the endorsement does not rescue an employer that should have bought state-fund coverage and did not. Confirm the state-fund account is active.
Quoting and selling notes
- Ask every multistate account whether it has employees, even remote workers, in ND, OH, WA or WY. Those employees need state-fund coverage plus this endorsement on the private policy.
- If an umbrella lists employers liability as required underlying coverage, check that monopolistic-state operations are scheduled here so there is no gap under the umbrella.
- Coordinate with any other stop gap coverage the insured buys so a state is neither duplicated nor left out.
Related forms
Base policy WC 00 00 00; Information Page WC 00 00 01.
