NCCI exclusion · workers compensation

WC 00 03 15 Domestic and Agricultural Workers Exclusion Endorsement

Filings
128
latest Sep 16, 2026
Filing companies
78
27 carrier groups
States
12
Latest edition
Original

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.

EditionFilingsCompaniesStatesFiledDocument
OriginalLatest1287812Jan 2022 to Sep 2026View 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%).

Data from admitted P&C filings with state insurance departments, submitted Nov 2021 to Sep 2026, excluding withdrawn and rejected filings.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.

CarrierFilingsStatesEditions, most filed firstLast filed
Brookfield Wealth Solutions Group5 group companies filed it, led by Argonaut Insurance Company and Argonaut-Midwest Insurance Company201OriginalJun 25, 2026
Nationwide Corporation Group9 group companies filed it, led by AMCO Insurance Company and Crestbrook Insurance Company201OriginalJun 30, 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
State Farm GroupState Farm Fire and Casualty Company51OriginalMay 4, 2026

View all 27 carrier groups

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.

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 25, 2026American National Property And Casualty CompanyCOOriginalANPC-134996042
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

View all 128 filings

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