Workers Compensation insurance forms

What forms make up a workers compensation policy

An NCCI workers compensation policy is built from coverage forms, a declarations page and endorsements. The coverage form is WC 00 00 00 Workers Compensation and Employers Liability Insurance Policy (edition C, filed by 75 carrier groups). WC 00 00 01 Information Page is the declarations page. Widely filed endorsements include WC 00 04 21 Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement (60), WC 00 04 19 Part Five, Premium Amendatory Endorsement (51), and WC 00 04 06 Premium Discount Endorsement (45).

Standard form pages
55
Forms filed, all insurers
5,111
Insurers filing
753
States
50
Latest filing
Nov 10, 2026

Form programs

Forms from the largest workers compensation insurers and advisory organizations.

Most filed workers compensation forms

Filings, past five years
  • WC 00 00 01Information PageNCCI1,294
  • WC 00 04 19Part Five, Premium Amendatory EndorsementNCCI404
  • WC 00 00 00Workers Compensation and Employers Liability Insurance PolicyNCCI391
  • WC 00 04 21Catastrophe (Other Than Certified Acts of Terrorism) Premium EndorsementNCCI287
  • WC 00 04 06Premium Discount EndorsementNCCI218
  • WC 00 03 13Waiver of Our Right to Recover From Others EndorsementNCCI199
  • WC 00 04 22Terrorism Risk Insurance Program Reauthorization Act Disclosure EndorsementNCCI189
  • WC 00 03 08Partners, Officers and Others Exclusion EndorsementNCCI175
  • WC 00 03 03Employers Liability Coverage EndorsementNCCI167
  • WC 00 03 11Voluntary Compensation and Employers Liability Coverage EndorsementNCCI164