What it does
WC 00 04 25 is added to Part Five (Premium). It states that premium is adjusted by an experience rating modification factor, that the factor shown on the Information Page may be revised and applied to the policy in accordance with the insurer's manuals and endorsements, and that the insurer will issue an endorsement showing the revised factor, if different, when it is calculated. North Carolina's bureau posts edition 1-17; Minnesota's forms manual shows edition 5-17.
Who needs it
Experience-rated accounts where a modification could be revised after issue, for example because of a data correction, a ruling on an ownership change, or a recalculation under the rating plan. It differs from WC 00 04 03, which is used when no factor was available at issue, and from WC 00 04 12, which applies a contingent factor.
Key provisions
- Revision follows the manual rules; the endorsement is notice that premium may change as a result.
- A revised factor can increase or decrease premium.
Quoting and selling notes
- Review the bureau's experience rating worksheet each year, and ask the insured about ownership changes and claim reserve updates that could trigger a revision.
- Explain that revisions can produce a mid-term or audit adjustment even after the policy expires.
Related forms
Experience modification WC 00 04 03; contingent factor WC 00 04 12; ownership change WC 00 04 14.
