Coverage description
A National Council on Compensation Insurance (NCCI) standard form. It adds voluntary compensation for your residence employees, paying them the benefits a scheduled state's workers compensation law would provide even though that law does not require it, plus employers liability coverage with scheduled limits.
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 if you and your residence employees were subject to the workers compensation law shown in the Schedule.”
WC 00 03 12 A
What voluntary compensation pays. Benefits are measured by the state law entered in the schedule, as if that law applied to you and your full-time or part-time domestic workers, and are paid to the people that law would entitle.
“Any obligation imposed by a workers compensation or occupational disease law or any similar law.”
WC 00 03 12 A
What it does not replace. Voluntary compensation is excluded wherever a workers compensation, occupational disease or similar law already imposes the obligation, so it pays only where no law requires benefits for the residence employee.
“Bodily injury arising out of any of your business pursuits.”
WC 00 03 12 A
Injuries from your business are outside it. Both the voluntary compensation and the employers liability parts exclude bodily injury arising out of your business pursuits, along with bodily injury you intentionally cause or aggravate.
“Release you and us, in writing, of all responsibility for the injury or death.”
WC 00 03 12 A
What the worker gives up to be paid. Before payment, the injured person or survivors must sign a release, transfer their recovery rights against others to the insurer and cooperate. If they claim damages from you or the insurer instead, the duty to pay ends at once.
How the form has changed
Filed copies with stored text carry revision A (Ed. 07-11); the original 04-84 edition appears only on two Intact filings with no stored text.
Editions
Revision letters as filed, newest first. Filing counts include every state submission that lists the edition.
| Edition | Filings | Companies | States | Filed | Document |
|---|---|---|---|---|---|
| ALatest | 84 | 45 | 7 | Mar 2022 to Sep 2026 | View PDF |
1 other edition date appears in one or two filings each, often carrier-specific versions: Original.
What the filings show
- Edition in use: in the past 12 months, 25 companies filed edition A.
- WC 00 01 01 (Defense Base Act Coverage Endorsement) is filed alongside it most often, in 86 of the same filings (100%).
Filed under
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 12, out of 19 in total.
| Carrier | Filings | States | Editions, most filed first | Last filed |
|---|---|---|---|---|
| Brookfield Wealth Solutions Group4 group companies filed it, led by Argonaut Insurance Company and Argonaut-Midwest Insurance Company | 19 | 1 | A | Jun 4, 2026 |
| Nationwide Corporation Group3 group companies filed it, led by Crestbrook Insurance Company and National Casualty Company | 10 | 1 | A | Jun 30, 2026 |
| AXA Insurance Group5 group companies filed it, led by Greenwich Insurance Company and XL Insurance America, Inc. | 6 | 2 | A | Jun 23, 2026 |
| RLI Insurance GroupRLI Insurance Company | 5 | 1 | A | Aug 18, 2026 |
| Sompo Group2 group companies filed it, led by Sompo America Fire and Marine Insurance Company and Sompo America Insurance Company | 5 | 1 | A | Jun 15, 2026 |
| State Farm GroupState Farm Fire and Casualty Company | 5 | 1 | A | May 4, 2026 |
| THE Hanover Insurance Group6 group companies filed it, led by Allmerica Financial Alliance Insurance Company and Allmerica Financial Benefit Insurance Company | 5 | 1 | A | Jun 23, 2026 |
| Arch Insurance Group2 group companies filed it, led by Arch Indemnity Insurance Company and Arch Insurance Company | 4 | 1 | A | Apr 8, 2026 |
| Louisiana Workers Compensation GroupPrescient National Insurance Company | 4 | 1 | A | Jul 2, 2025 |
| Tokio Marine Holdings Incorporated Group2 group companies filed it, led by Safety First Insurance Company and Safety National Casualty Corporation | 4 | 1 | A | May 14, 2025 |
States
Number of filings that include WC 00 03 12 in each state, Nov 2021 to Sep 2026. Darker states have more filings.
Often filed with
Standard-style form numbers that appear in the same filings most often.
- WC 00 01 01Defense Base Act Coverage Endorsement86 filings
- WC 00 01 04Federal Employers' Liability Act Coverage Endorsement86 filings
- WC 00 01 06Longshoremen's and Harbor Workers' Compensation Act Coverage Endorsement86 filings
- WC 00 01 08Nonappropriated Fund Instrumentalities Act Coverage Endorsement86 filings
- WC 00 01 11Migrant and Seasonal Agricultural Worker Protection Act Coverage86 filings
- WC 00 03 01Alternate Employer Endorsement86 filings
- WC 00 03 02Designated Workplaces Exclusion Endorsement86 filings
- WC 00 03 03Employers Liability Coverage Endorsement86 filings
- WC 00 03 04Insurance Company as Insured Endorsement86 filings
- WC 00 03 05Joint Venture as Insured Endorsement86 filings
Recent filings
Latest filings that include this form number. Filed copies open in FilingFocus.
| Submitted | Company | State | Editions | Tracking number |
|---|---|---|---|---|
| Sep 16, 2026 | ZNAT Insurance Company | CT | A | ZICO-135090521 |
| Aug 18, 2026 | RLI Insurance Company | CO | A | RLSC-135057018 |
| Jun 30, 2026 | Crestbrook Insurance Companyand 1 more | CO | A | NWPP-135003409 |
| Jun 30, 2026 | National Casualty Company | CO | A | NWPP-135004216 |
| 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 |
| Jun 12, 2026 | All America Insurance Companyand 1 more | CO | A | CEMC-134982050 |
| Jun 4, 2026 | Argonaut-Midwest Insurance Company | CO | A | ARGN-134974739 |
| Jun 4, 2026 | Argonaut Insurance Company | CO | A | ARGN-134974742 |
| Jun 4, 2026 | Rockwood Casualty Insurance Company | CO | A | ARGN-134974764 |
| May 4, 2026 | State Farm Fire and Casualty Company | CO | A | SFMA-134912629 |
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 03 11 Voluntary Compensation and Employers Liability Coverage Endorsement
- WC 00 04 03 Experience Rating Modification Factor Endorsement
- WC 00 04 04 Pending Rate Change Endorsement