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NCCI endorsement · workers compensation

WC 00 03 04 Insurance Company as Insured Endorsement

Filings
142
latest Sep 16, 2026
Filing companies
84
32 carrier groups
States
22
Latest edition
Original
View PDFs

Coverage description

A National Council on Compensation Insurance (NCCI) standard form. It states that when the insured is an insurance company, the policy does not cover its obligations as a workers compensation insurer or reinsurer of other employers.

Updated

What the form says

Key clauses from the original edition, which has not been revised, quoted as filed.

“The policy does not cover your obligations as a workers compensation reinsurer or insurer of other employers.”

WC 00 03 04

What is excluded. The policy answers for the insurance company as an employer of its own workers. Liabilities it takes on by insuring or reinsuring other employers' workers compensation are outside it.

“is effective on the date issued unless otherwise stated”

WC 00 03 04

When the endorsement takes effect. Added during the policy term, the endorsement applies from the date it is issued unless another date is written in.

How the form has changed

Filed copies carry the original 4-84 edition, with no revision letter.

Editions

Edition dates as filed, newest first. Filing counts include every state submission that lists the edition.

EditionFilingsCompaniesStatesFiledDocument
OriginalLatest1428422Jan 2022 to Sep 2026View PDF

What the filings show

  • Edition in use: in the past 12 months, 49 companies filed the original edition.
  • WC 00 03 05 (Joint Venture as Insured Endorsement) is filed alongside it most often, in 141 of the same filings (99%).

Filed under

Standard WC 117WC 23Employers Liability WC 2

Data from admitted P&C filings with state insurance departments, submitted Nov 2021 to Sep 2026, excluding withdrawn and rejected filings. One filing can cover several affiliated companies.

Carriers filing this form

The 10 carrier groups with the most filings that include WC 00 03 04, out of 32 in total.

CarrierFilingsStatesEditions, most filed firstLast filed
Nationwide Corporation Group9 group companies filed it, led by AMCO Insurance Company and Crestbrook Insurance Company201OriginalJun 30, 2026
Brookfield Wealth Solutions Group4 group companies filed it, led by Argonaut Insurance Company and Argonaut-Midwest Insurance Company191OriginalJun 4, 2026
United Fire & CAS GroupUnited Fire and Casualty Company1512OriginalMay 4, 2026
AXA Insurance Group5 group companies filed it, led by Greenwich Insurance Company and XL Insurance America, Inc.62OriginalJun 23, 2026
Acuity, A Mutual Insurance Company62OriginalJul 1, 2026
Tokio Marine Holdings Incorporated Group2 group companies filed it, led by Safety First Insurance Company and Safety National Casualty Corporation62OriginalMay 14, 2025
Donegal Group3 group companies filed it, led by Donegal Mutual Insurance Company and Mountain States Indemnity Company51OriginalApr 27, 2026
Intact Financial Group3 group companies filed it, led by Atlantic Specialty Insurance Company and OBI America Insurance Company51OriginalJun 24, 2026
RLI Insurance GroupRLI Insurance Company51OriginalAug 18, 2026
Sompo Group2 group companies filed it, led by Sompo America Fire and Marine Insurance Company and Sompo America Insurance Company51OriginalJun 15, 2026

View all 32 carrier groups

How the largest insurers handle WC 00 03 04

Groups among the largest workers compensation insurers that filed WC 00 03 04 or their own version in the past five years.

States

Number of filings that include WC 00 03 04 in each state, Nov 2021 to Sep 2026. Darker states have more filings.

Tennessee: 0 filingsTNAlabama: 1 filingAL1Florida: 0 filingsFLGeorgia: 0 filingsGAOklahoma: 2 filingsOK2South Carolina: 2 filingsSC2Arkansas: 0 filingsARMissouri: 1 filingMO1Indiana: 1 filingIN1Louisiana: 1 filingLA1Ohio: 0 filingsOHWisconsin: 0 filingsWITexas: 0 filingsTXKentucky: 1 filingKY1Iowa: 0 filingsIAKansas: 0 filingsKSMississippi: 1 filingMS1North Carolina: 0 filingsNCNebraska: 0 filingsNESouth Dakota: 0 filingsSDMontana: 2 filingsMT2New Hampshire: 0 filingsNHVirginia: 0 filingsVAArizona: 2 filingsAZ2Pennsylvania: 1 filingPA1Rhode Island: 0 filingsRIMichigan: 4 filingsMI4Alaska: 0 filingsAKDistrict of Columbia: 0 filingsDCIdaho: 1 filingID1Maryland: 0 filingsMDWest Virginia: 0 filingsWVUtah: 0 filingsUTWyoming: 4 filingsWY4Delaware: 0 filingsDENew Mexico: 1 filingNM1Colorado: 107 filingsCO107Connecticut: 1 filingCT1Maine: 0 filingsMENorth Dakota: 2 filingsND2Illinois: 1 filingIL1Minnesota: 0 filingsMNNew Jersey: 0 filingsNJNew York: 0 filingsNYMassachusetts: 0 filingsMAWashington: 2 filingsWA2Oregon: 0 filingsORVermont: 0 filingsVTCalifornia: 0 filingsCANevada: 1 filingNV1Hawaii: 3 filingsHI3
FewerMore filingsNone

Often filed with

Standard-style form numbers that appear in the same filings most often.

  • WC 00 03 05Joint Venture as Insured Endorsement141 filings
  • WC 00 03 01Alternate Employer Endorsement140 filings
  • WC 00 03 08Partners, Officers and Others Exclusion Endorsement139 filings
  • WC 00 03 13Waiver of Our Right to Recover From Others Endorsement139 filings
  • WC 00 04 06Premium Discount Endorsement139 filings
  • WC 00 04 03Experience Rating Modification Factor Endorsement136 filings
  • WC 00 03 02Designated Workplaces Exclusion Endorsement134 filings
  • WC 00 03 10Sole Proprietors, Partners, Officers and Others Coverage Endorsement134 filings
  • WC 00 03 11Voluntary Compensation and Employers Liability Coverage Endorsement133 filings
  • WC 00 04 04Pending Rate Change Endorsement133 filings

Recent filings

Latest filings that include this form number. Filed copies open in FilingFocus.

SubmittedCompanyStateEditionsTracking number
Sep 16, 2026ZNAT Insurance CompanyCTOriginalZICO-135090521
Aug 18, 2026RLI Insurance CompanyCOOriginalRLSC-135057018
Jul 1, 2026Acuity, A Mutual Insurance CompanyCOOriginalACUT-134982793
Jun 30, 2026American Casualty Company of Reading, Pennsylvaniaand 5 moreCOOriginalCNAB-135003197
Jun 30, 2026Crestbrook Insurance Companyand 1 moreCOOriginalNWPP-135003409
Jun 30, 2026National Casualty CompanyCOOriginalNWPP-135004216
Jun 24, 2026Atlantic Specialty Insurance Companyand 2 moreCOOriginalBEAC-134978198
Jun 23, 2026Allmerica Financial Alliance Insurance Companyand 5 moreCOOriginalHNVX-134968029
Jun 23, 2026AXA XL Insurance Company Americasand 3 moreCOOriginalXLAM-134996276
Jun 15, 2026Sompo America Fire and Marine Insurance Companyand 1 moreCOOriginalSMPJ-134970923
Jun 12, 2026All America Insurance Companyand 1 moreCOOriginalCEMC-134982050
Jun 11, 2026Nationwide Assurance Companyand 3 moreCOOriginalNWPP-G134983730

View all 142 filings

Most filed NCCI WC forms

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