What it does
WC 00 04 03 (Ed. 4-84) is a short notice added when the policy is issued before the rating bureau has published the insured's experience rating modification. It says the premium will be adjusted by a modification factor, that the factor was not available when the policy was issued, that any factor shown on the Information Page is an estimate, and that the insurer will issue an endorsement showing the proper factor, if different, once it is calculated.
Who needs it
Any account eligible for experience rating whose modification is late, for example because payroll or loss data from a prior carrier has not reached the bureau, or the account just became eligible. NCCI's Information Page notes direct carriers to show the modification in Item 4 unless it is not available, and then to refer to this endorsement.
Key provisions
- The final factor applies to the whole policy, so a late modification can raise or lower premium retroactively to inception.
Quoting and selling notes
- Prepare the insured for a mid-term premium change when this endorsement is attached, especially if losses worsened.
- Check the bureau worksheet once published: missing payroll, unreported ownership changes or open claims with high reserves can be corrected with the bureau.
- For a factor that is later revised (for example after a data correction), carriers use WC 00 04 25; for a factor based on incomplete data that may be revised, WC 00 04 12.
Related forms
Revision WC 00 04 25; contingent factor WC 00 04 12; ownership change WC 00 04 14; Information Page WC 00 00 01.
