Coverage description
A National Council on Compensation Insurance (NCCI) standard form. It adds voluntary compensation, paying a scheduled group of employees the benefits a named state's workers compensation law would provide even though the law does not require it, with employers liability coverage for those injuries.
Updated
What the form says
Key clauses from edition A, the latest revision, quoted as filed.
“We will pay an amount equal to the benefits that would be required of you”
WC 00 03 11 A
What voluntary compensation pays. Benefits are measured by the workers compensation law named in the schedule, as if you and the listed employees were subject to it.
“The bodily injury must arise out of and in the course of employment”
WC 00 03 11 A · New in this edition
Which injuries qualify. Revision A uses the usual workers compensation test: the injury must arise out of the work as well as happen in the course of it, for a scheduled employee working in a scheduled state.
“Release you and us, in writing, of all responsibility for the injury or death.”
WC 00 03 11 A
What the worker gives up to be paid. Before payment, the injured person or survivors must sign a release and transfer recovery rights to the insurer. If they claim damages from you or the insurer instead, the duty to pay ends.
“any obligation imposed by a workers compensation or occupational disease law, or any similar law.”
WC 00 03 11 A
What it does not replace. Voluntary compensation does not pay what a workers compensation, occupational disease or similar law already requires; it pays only where no law imposes the obligation.
How the form has changed
1 change across 1 revision, newest first. Each edition is compared with the one before it, using wording from filed copies.
Edition A
Compared with the original editionLatest editionQualifying injuries must arise out of and occur in the course of employment, where the original required only that they occur in the course of employment.
Original edition
“The bodily injury must occur in the course of employment”
Edition A
“The bodily injury must arise out of and in the course of employment”
Editions
Revision letters as filed, newest first. Filing counts include every state submission that lists the edition.
What the filings show
- Edition in use: in the past 12 months, 60 companies filed edition A and 8 companies filed the original edition.
- WC 00 04 22 (Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement) is filed alongside it most often, in 157 of the same filings (96%).
Filed under
Data from admitted P&C filings with state insurance departments, submitted Nov 2021 to Nov 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 11, out of 35 in total.
| Carrier | Filings | States | Editions, most filed first | Last filed |
|---|---|---|---|---|
| Nationwide Corporation Group11 group companies filed it, led by Crestbrook Insurance Company and Nationwide Agribusiness Insurance Company | 27 | 5 | AOriginal | Jun 30, 2026 |
| Brookfield Wealth Solutions Group4 group companies filed it, led by Argonaut Insurance Company and Argonaut-Midwest Insurance Company | 19 | 1 | A | Jun 4, 2026 |
| United Fire & CAS GroupUnited Fire and Casualty Company | 15 | 12 | A | May 4, 2026 |
| AXA Insurance Group5 group companies filed it, led by Greenwich Insurance Company and XL Insurance America, Inc. | 6 | 2 | A | Jun 23, 2026 |
| Acuity, A Mutual Insurance Company | 6 | 2 | A | Jul 1, 2026 |
| Tokio Marine Holdings Incorporated Group2 group companies filed it, led by Safety First Insurance Company and Safety National Casualty Corporation | 6 | 2 | A | May 14, 2025 |
| Donegal Group3 group companies filed it, led by Donegal Mutual Insurance Company and Mountain States Indemnity Company | 5 | 1 | A | Apr 27, 2026 |
| Intact Financial Group3 group companies filed it, led by Atlantic Specialty Insurance Company and OBI America Insurance Company | 5 | 1 | A | Jun 24, 2026 |
| Mutual Capital Group Incorporated GroupIllinois Casualty Company | 5 | 5 | A | Nov 2, 2026 |
| RLI Insurance GroupRLI Insurance Company | 5 | 1 | A | Aug 18, 2026 |
How the largest insurers handle WC 00 03 11
Groups among the largest workers compensation insurers that filed WC 00 03 11 or their own version in the past five years.
- Travelers GroupFiles its own version: XC 99 0009 (00) Voluntary Compensation and Employers Liability Coverage Endorsement (40 states)
- Zurich Insurance GroupUses WC 00 03 11 in 1 filing
States
Number of filings that include WC 00 03 11 in each state, Nov 2021 to Nov 2026. Darker states have more filings.
Often filed with
Standard-style form numbers that appear in the same filings most often.
- WC 00 04 22Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement157 filings
- WC 00 03 08Partners, Officers and Others Exclusion Endorsement155 filings
- WC 00 00 00Workers Compensation and Employers Liability Insurance Policy152 filings
- WC 00 03 13Waiver of Our Right to Recover From Others Endorsement147 filings
- WC 00 04 03Experience Rating Modification Factor Endorsement147 filings
- WC 00 04 21Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement147 filings
- WC 00 03 10Sole Proprietors, Partners, Officers and Others Coverage Endorsement146 filings
- WC 00 04 14Notification of Change in Ownership Endorsement145 filings
- WC 00 04 06Premium Discount Endorsement144 filings
- WC 00 03 02Designated Workplaces Exclusion Endorsement143 filings
Recent filings
Latest filings that include this form number. Filed copies open in FilingFocus.
| Submitted | Company | State | Editions | Tracking number |
|---|---|---|---|---|
| Nov 2, 2026 | AmFed Advantage Insurance Companyand 3 more | WA | A | GREY-135137891 |
| Nov 2, 2026 | Illinois Casualty Company | OR | A | ILCC-135079829 |
| Sep 16, 2026 | ZNAT Insurance Company | CT | A | ZICO-135090521 |
| Aug 18, 2026 | RLI Insurance Company | CO | A | RLSC-135057018 |
| Jul 1, 2026 | Acuity, A Mutual Insurance Company | CO | A | ACUT-134982793 |
| Jun 30, 2026 | American Casualty Company of Reading, Pennsylvaniaand 5 more | CO | A | CNAB-135003197 |
| Jun 30, 2026 | Crestbrook Insurance Companyand 1 more | CO | A | NWPP-135003409 |
| Jun 30, 2026 | National Casualty Company | CO | A | NWPP-135004216 |
| Jun 24, 2026 | Atlantic Specialty Insurance Companyand 2 more | CO | A | BEAC-134978198 |
| Jun 23, 2026 | Allmerica Financial Alliance Insurance Companyand 5 more | CO | A | HNVX-134968029 |
| Jun 23, 2026 | AXA XL Insurance Company Americasand 3 more | CO | A | XLAM-134996276 |
| Jun 15, 2026 | Sompo America Fire and Marine Insurance Companyand 1 more | CO | A | SMPJ-134970923 |
Most filed NCCI WC forms
- WC 00 00 01 Information Page
- WC 00 04 19 Part Five, Premium Amendatory Endorsement
- WC 00 00 00 Workers Compensation and Employers Liability Insurance Policy
- WC 00 04 21 Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement
- WC 00 04 06 Premium Discount Endorsement
- WC 00 03 13 Waiver of Our Right to Recover From Others Endorsement
- WC 00 04 22 Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement
- WC 00 03 08 Partners, Officers and Others Exclusion Endorsement
- WC 00 03 03 Employers Liability Coverage Endorsement
- WC 00 04 03 Experience Rating Modification Factor Endorsement
- WC 00 04 04 Pending Rate Change Endorsement
- WC 00 03 01 Alternate Employer Endorsement