What it does
WC 00 06 03 (Ed. 2-91) applies only to Part One for the states in its Schedule. Part One then applies only to benefits in excess of the deductible amount, which can be stated as an indemnity deductible, a medical deductible, or a combined indemnity-and-medical deductible.
Key provisions
- The deductible applies separately to each claim for bodily injury by accident or disease, unless the law requires a per-accident or per-disease basis, in which case it applies per accident or disease regardless of how many people are injured.
- The insurer pays the deductible amount and the insured must reimburse it within 30 days after notice. If the insured does not, the insurer may cancel and keep unearned premium to offset what it paid.
- If the statute requires or allows the employer to pay the deductible directly, the insured pays the injured worker and the insurer acts as guarantor, with the same 30-day reimbursement and cancellation rights.
Who needs it
Small and mid-size employers looking for a premium credit in states with a benefits deductible law. Employees always receive full benefits; the deductible is a matter between the employer and the insurer.
Quoting and selling notes
- Ask which deductible options the state allows and the premium credit for each; compare the credit with expected claim frequency.
- The deductible applies per claim, so a high-frequency account can owe more in reimbursements than it saves.
- Wisconsin's rating bureau lists WC 00 06 03 among NCCI endorsements not accepted in Wisconsin, and Massachusetts and Texas use state deductible endorsements (WC 20 06 02, WC 42 06 02, WC 42 06 03, WC 42 06 04).
Related forms
Retrospective plan WC 00 05 03; base policy WC 00 00 00.
