1. Forms
  2. WC
  3. WC-00-03-13

What it does

Part One of the policy gives the insurer the employer's rights to recover benefits from anyone liable for an injury. WC 00 03 13 (Ed. 4-84) states that the insurer will not enforce that right against the person or organization named in the Schedule. An optional sentence in parentheses limits the waiver to the extent the insured performs work under a written contract that requires it. The agreement does not operate to benefit anyone not named in the Schedule.

Who needs it

Businesses that work on someone else's premises or projects under contracts requiring a waiver of subrogation: contractors and subcontractors on construction projects, trucking and delivery firms, staffing agencies, janitorial, security and landscaping contractors, and vendors to large retailers and property owners.

Key provisions

  • Specific or blanket: the Schedule can name a person or organization or use blanket wording tied to written contracts. The North Carolina bureau allows only a blanket waiver on residual market policies.
  • Premium: a charge may apply in both the voluntary and assigned risk markets under the Basic Manual rule for waivers. New York's manual notes, for example, set 2% to 10% of manual premium for blanket waivers and 5% to 10% per named party for specific waivers, each with a $250 minimum per policy.
  • The waiver covers the insurer's rights only; it does not make the other party an insured.

Quoting and selling notes

  • Read the contract for the exact requirement (blanket or specific, which parties, all states or one). The optional "written contract" sentence means the waiver does not apply to a party without a contract requiring it.
  • State versions replace this form in some places: California uses WC 04 03 06 and Texas uses WC 42 03 04, each with its own premium wording.
  • When the contract also requires protection against the employee's claim being brought against the customer as employer, add the alternate employer endorsement WC 00 03 01.

Related forms

California WC 04 03 06; Texas WC 42 03 04; alternate employer WC 00 03 01; base policy WC 00 00 00.