Coverage description
A National Council on Compensation Insurance (NCCI) standard form. It removes from a professional employer organization's (PEO's) own policy the workers it leases to the clients listed in the schedule and to clients added later, leaving the policy to cover its direct workers.
Updated
What the form says
Key clauses from edition A, the latest revision, quoted as filed.
“does not provide coverage for workers you lease to any clients listed below”
WC 00 03 21 A
Which leased workers are excluded. The insured here is the PEO. Workers it leases to the clients named in the schedule are not covered by its policy.
“or others added subsequent to policy issuance even if not endorsed on the policy”
WC 00 03 21 A · New in this edition
Clients taken on after the policy starts. The exclusion also reaches workers leased to clients added after the policy is issued, even when no endorsement adds them to the schedule.
“which only covers your direct (non-leased) workers”
WC 00 03 21 A · New in this edition
What the policy still covers. Revision A states the purpose outright: with this endorsement attached, the PEO's policy covers its own direct workers and not the workers it places with clients.
“Any changes to such information must be reported to the carrier immediately.”
WC 00 03 21 A · New in this edition
Your duty to report changes. The insured must tell the insurer right away when the client information on the endorsement changes.
How the form has changed
3 changes 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 editionExtends the exclusion from the clients listed in the schedule to clients added after the policy is issued, even if no endorsement adds them.
Original edition
“Your policy does not provide coverage for workers you lease to the clients listed below.”
Edition A
“or others added subsequent to policy issuance even if not endorsed on the policy”
Adds a duty to report changes in the client information to the insurer immediately.
Original edition
Not in this edition
Edition A
“Any changes to such information must be reported to the carrier immediately.”
Renames the labor contractor a PEO and states that the policy covers only your direct, non-leased workers, where the original said the endorsement applied to workers you provided to a client under an employee leasing arrangement.
Original edition
“This endorsement applies only with respect to workers provided by you to a client under an employee leasing arrangement”
Edition A
“which only covers your direct (non-leased) workers”
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, 33 companies filed the original edition and 12 companies filed edition A.
- The newer revision, edition A, first appears Mar 22, 2022 and has been filed by 21 companies in 8 states so far.
- WC 00 03 22 (Employee Leasing Client Exclusion Endorsement) is filed alongside it most often, in 91 of the same filings (99%).
Filed under
Data from admitted P&C filings with state insurance departments, submitted Nov 2021 to Aug 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 21, out of 22 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 | Original | Jun 4, 2026 |
| AXA Insurance Group5 group companies filed it, led by Greenwich Insurance Company and XL Insurance America, Inc. | 6 | 2 | Original | Jun 23, 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 |
| 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 |
| THE Hanover Insurance Group6 group companies filed it, led by Allmerica Financial Alliance Insurance Company and Allmerica Financial Benefit Insurance Company | 5 | 1 | Original | Jun 23, 2026 |
| Arch Insurance Group2 group companies filed it, led by Arch Indemnity Insurance Company and Arch Insurance Company | 4 | 1 | Original | Apr 8, 2026 |
| Fairfax Financial Group2 group companies filed it, led by Zenith Insurance Company and ZNAT Insurance Company | 4 | 4 | A | Sep 29, 2023 |
How the largest insurers handle WC 00 03 21
Groups among the largest workers compensation insurers that filed WC 00 03 21 or their own version in the past five years.
- Hartford Fire & CAS GroupUses WC 00 03 21 in 1 filing
States
Number of filings that include WC 00 03 21 in each state, Nov 2021 to Aug 2026. Darker states have more filings.
Often filed with
Standard-style form numbers that appear in the same filings most often.
- WC 00 03 22Employee Leasing Client Exclusion Endorsement91 filings
- WC 00 03 20Labor Contractor Endorsement88 filings
- WC 00 03 23Multiple Coordinated Policy Endorsement86 filings
- WC 00 01 06Longshoremen's and Harbor Workers' Compensation Act Coverage Endorsement85 filings
- WC 00 03 05Joint Venture as Insured Endorsement85 filings
- WC 00 03 09Rural Utilities Service Endorsement85 filings
- WC 00 03 11Voluntary Compensation and Employers Liability Coverage Endorsement84 filings
- WC 00 03 13Waiver of Our Right to Recover From Others Endorsement84 filings
- WC 00 01 04Federal Employers' Liability Act Coverage Endorsement83 filings
- WC 00 01 08Nonappropriated Fund Instrumentalities Act Coverage Endorsement83 filings
Recent filings
Latest filings that include this form number. Filed copies open in FilingFocus.
| Submitted | Company | State | Editions | Tracking number |
|---|---|---|---|---|
| Aug 18, 2026 | RLI Insurance Company | CO | Original | RLSC-135057018 |
| Jun 30, 2026 | American Casualty Company of Reading, Pennsylvaniaand 5 more | CO | Original | CNAB-135003197 |
| 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 |
| Jun 4, 2026 | Argonaut-Midwest Insurance Company | CO | Original | ARGN-134974739 |
| Jun 4, 2026 | Argonaut Insurance Company | CO | Original | ARGN-134974742 |
| Jun 4, 2026 | Rockwood Casualty Insurance Company | CO | Original | ARGN-134974764 |
| May 27, 2026 | Alaska National Insurance Company | SC | AOriginal | ALNI-134962436 |
| May 27, 2026 | CopperPoint Casualty Insurance Companyand 1 more | SC | AOriginal | COPP-134964112 |
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