Coverage description
A National Council on Compensation Insurance (NCCI) standard form. It excludes the farm or agricultural workers and domestic or household workers described in its schedule from the policy and its premium basis, and has you repay the insurer for any payment it is required to make for them.
Updated
What the form says
Key clauses from the original edition, which has not been revised, quoted as filed.
“The policy does not cover bodily injury to any person described in the Schedule.”
WC 00 03 15
Who is excluded. The schedule has two entries, farm or agricultural workers and domestic or household workers. Injuries to anyone described there are outside both workers compensation and employers liability under the policy.
“The premium basis for the policy does not include the remuneration of such persons.”
WC 00 03 15
How premium is affected. Pay to the excluded workers is left out of the payroll the premium is charged on, so the exclusion and the premium match.
“You will reimburse us for any payment we are required to make because of bodily injury to such persons.”
WC 00 03 15
If the insurer has to pay anyway. Where a law still makes the insurer pay for an excluded worker's injury, you owe the insurer that amount back.
How the form has changed
Filed copies carry the original edition, with no revision letter. Most print Ed. 4-84; one 9-85 print has the same wording.
Editions
Edition dates as filed, newest first. Filing counts include every state submission that lists the edition.
| Edition | Filings | Companies | States | Filed | Document |
|---|---|---|---|---|---|
| OriginalLatest | 128 | 78 | 12 | Jan 2022 to Sep 2026 | View PDF |
What the filings show
- Edition in use: in the past 12 months, 50 companies filed the original edition.
- WC 00 03 05 (Joint Venture as Insured Endorsement) is filed alongside it most often, in 127 of the same filings (99%).
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Data from admitted P&C filings with state insurance departments, submitted Nov 2021 to Sep 2026, excluding withdrawn and rejected filings.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 15, out of 27 in total.
| Carrier | Filings | States | Editions, most filed first | Last filed |
|---|---|---|---|---|
| Brookfield Wealth Solutions Group5 group companies filed it, led by Argonaut Insurance Company and Argonaut-Midwest Insurance Company | 20 | 1 | Original | Jun 25, 2026 |
| Nationwide Corporation Group9 group companies filed it, led by AMCO Insurance Company and Crestbrook Insurance Company | 20 | 1 | Original | Jun 30, 2026 |
| AXA Insurance Group5 group companies filed it, led by Greenwich Insurance Company and XL Insurance America, Inc. | 6 | 2 | Original | Jun 23, 2026 |
| Acuity, A Mutual Insurance Company | 6 | 2 | Original | 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 | Original | May 14, 2025 |
| Donegal Group3 group companies filed it, led by Donegal Mutual Insurance Company and Mountain States Indemnity Company | 5 | 1 | Original | Apr 27, 2026 |
| Intact Financial Group3 group companies filed it, led by Atlantic Specialty Insurance Company and OBI America Insurance Company | 5 | 1 | Original | Jun 24, 2026 |
| RLI Insurance GroupRLI Insurance Company | 5 | 1 | Original | 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 | Original | Jun 15, 2026 |
| State Farm GroupState Farm Fire and Casualty Company | 5 | 1 | Original | May 4, 2026 |
States
Number of filings that include WC 00 03 15 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 03 05Joint Venture as Insured Endorsement127 filings
- WC 00 03 04Insurance Company as Insured Endorsement126 filings
- WC 00 03 08Partners, Officers and Others Exclusion Endorsement125 filings
- WC 00 04 06Premium Discount Endorsement125 filings
- WC 00 03 01Alternate Employer Endorsement124 filings
- WC 00 03 02Designated Workplaces Exclusion Endorsement124 filings
- WC 00 03 13Waiver of Our Right to Recover From Others Endorsement124 filings
- WC 00 03 10Sole Proprietors, Partners, Officers and Others Coverage Endorsement123 filings
- WC 00 04 03Experience Rating Modification Factor Endorsement123 filings
- WC 00 03 11Voluntary Compensation and Employers Liability Coverage Endorsement122 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 | Original | ZICO-135090521 |
| Aug 18, 2026 | RLI Insurance Company | CO | Original | RLSC-135057018 |
| Jul 1, 2026 | Acuity, A Mutual Insurance Company | CO | Original | ACUT-134982793 |
| Jun 30, 2026 | American Casualty Company of Reading, Pennsylvaniaand 5 more | CO | Original | CNAB-135003197 |
| Jun 30, 2026 | Crestbrook Insurance Companyand 1 more | CO | Original | NWPP-135003409 |
| Jun 30, 2026 | National Casualty Company | CO | Original | NWPP-135004216 |
| Jun 25, 2026 | American National Property And Casualty Company | CO | Original | ANPC-134996042 |
| Jun 24, 2026 | Atlantic Specialty Insurance Companyand 2 more | CO | Original | BEAC-134978198 |
| Jun 23, 2026 | Allmerica Financial Alliance Insurance Companyand 5 more | CO | Original | HNVX-134968029 |
| Jun 23, 2026 | AXA XL Insurance Company Americasand 3 more | CO | Original | XLAM-134996276 |
| Jun 15, 2026 | Sompo America Fire and Marine Insurance Companyand 1 more | CO | Original | SMPJ-134970923 |
| Jun 12, 2026 | All America Insurance Companyand 1 more | CO | Original | CEMC-134982050 |
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