What it does
WC 04 03 06 is the California counterpart of WC 00 03 13. California workers compensation policies use WCIRB-numbered state forms (the WC 04 series), so the national waiver is replaced here. The insurer keeps its right to recover payments from anyone liable for a covered injury but will not enforce it against the person or organization named in the Schedule. Like the national form, it can include the optional limitation to work performed under a written contract that requires the waiver.
Key provisions
- Payroll records: the insured must keep payroll records accurately segregating the remuneration of employees while engaged in the work described in the Schedule.
- Premium: an additional premium stated as a percentage of the California workers compensation premium otherwise due on that remuneration. The percentage is filled in by the carrier.
- Schedule: a specific person or organization and job, or blanket wording such as any person or organization from whom the insured is required by written contract to obtain the waiver.
Who needs it
California contractors and subcontractors, landscapers, janitorial, security, trucking and staffing firms, and vendors whose contracts with public entities, owners or general contractors call for a waiver of subrogation on workers compensation.
Quoting and selling notes
- Because the charge is applied to remuneration for the scheduled work, ask the carrier how it will measure that payroll under a blanket waiver, and make sure the insured's payroll records separate it.
- When a contract requires a waiver for California work, request the California form for the California policy rather than the national WC 00 03 13.
Related forms
National waiver WC 00 03 13; Texas waiver WC 42 03 04.
