What it does
WC 00 04 14 A (Ed. 1-19) requires the insured to report any change in ownership to the insurer in writing within 90 days of the change. Change in ownership includes sales, purchases, other transfers, mergers, consolidations, dissolutions, formation of a new entity, and other changes covered by the experience rating plan. The form states that experience rating is mandatory for all eligible insureds and that the modification may change if the insured's ownership, or that of an entity combinable with it, changes.
Key provisions
- Failure to report, whether or not within 90 days, may result in revision of the modification used to determine premium.
- The requirement applies even if no experience modification currently applies to the policy.
Who needs it
The endorsement is attached broadly; it matters most for buyers and sellers of businesses, companies adding or dissolving affiliates, and contractors that form new entities. Because the modification may change when ownership changes, the carrier and rating bureau need the facts to apply the experience rating plan's ownership rules.
Quoting and selling notes
- Ask about any ownership change in the last three years and any planned transactions, and file the bureau's ownership change form promptly.
- Report name and entity changes on the policy with WC 89 06 00.
Related forms
Experience modification WC 00 04 03 and WC 00 04 25; Information Page change WC 89 06 00.
