Coverage description
A National Council on Compensation Insurance (NCCI) standard form. It adds workers compensation coverage for your residence employees, paying the benefits required by the law of the state where the residence premises is located and any scheduled state, 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 promptly when due the benefits required of you by the workers compensation law.”
WC 00 03 14 A
What the workers compensation part pays. The insurer pays the statutory benefits the law requires of you for injuries to your residence employees, for accidents during the policy period and diseases whose last exposure falls in it.
“of the state or territory where the residence premises is located and of any other state shown in Item 2 of the Schedule”
WC 00 03 14 A
Which state's law applies. The governing law is that of the residence premises state plus any state added in the schedule. The definition leaves out any law that provides nonoccupational benefits.
“This Coverage does not apply to bodily injury arising out of any of your business pursuits.”
WC 00 03 14 A
Injuries from your business are outside it. The workers compensation part has this single exclusion. The employers liability part repeats it and also excludes injury you intentionally cause or aggravate and obligations under a workers compensation or similar law.
“We will pay all sums that you legally must pay as damages because of bodily injury to your employees”
WC 00 03 14 A
What employers liability adds. Separate from statutory benefits, the insurer pays damages you owe for a covered injury, including damages a third party recovers from you over a claim against it, care and loss of services and consequential injury to family members, up to the per accident and disease limits in the schedule.
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 14, 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 14 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