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NCCI endorsement · workers compensation

WC 00 04 03 Experience Rating Modification Factor Endorsement

Filings
161
latest Nov 2, 2026
Filing companies
92
37 carrier groups
States
29
Latest edition
Original
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Coverage description

A National Council on Compensation Insurance (NCCI) standard form. It tells you the experience rating modification factor was not available when the policy was issued, so any factor shown is an estimate and the insurer will endorse the policy with the actual factor once calculated.

Updated

What the form says

Key clauses from the original edition, which has not been revised, quoted as filed.

“The factor was not available when the policy was issued.”

WC 00 04 03

Why the endorsement is attached. It is used when the policy starts before the experience modification for the period has been calculated.

“The factor, if any, shown on the Information Page is an estimate.”

WC 00 04 03

What the factor on the Information Page means. Any modification shown at issue is provisional, and premium based on it can change.

“We will issue an endorsement to show the proper factor, if different from the factor shown, when it is calculated.”

WC 00 04 03

How the premium is corrected. Once the actual factor is known, the insurer endorses the policy with it and the premium is adjusted by that factor.

How the form has changed

Filed copies carry the original 4-84 edition, with no revision letter.

Editions

Edition dates as filed, newest first. Filing counts include every state submission that lists the edition.

EditionFilingsCompaniesStatesFiledDocument
OriginalLatest1619229Dec 2021 to Nov 2026View PDF

What the filings show

  • Edition in use: in the past 12 months, 61 companies filed the original edition.
  • WC 00 03 08 (Partners, Officers and Others Exclusion Endorsement) is filed alongside it most often, in 156 of the same filings (97%).

Filed under

Standard WC 134WC 23Employers Liability WC 4

Data from admitted P&C filings with state insurance departments, submitted Nov 2021 to Nov 2026, excluding withdrawn and rejected filings.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 04 03, out of 37 in total.

CarrierFilingsStatesEditions, most filed firstLast filed
Brookfield Wealth Solutions Group5 group companies filed it, led by Argonaut Insurance Company and Argonaut-Midwest Insurance Company212OriginalJun 25, 2026
Nationwide Corporation Group9 group companies filed it, led by AMCO Insurance Company and Crestbrook Insurance Company201OriginalJun 30, 2026
United Fire & CAS GroupUnited Fire and Casualty Company1512OriginalMay 4, 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
Mutual Capital Group Incorporated GroupIllinois Casualty Company55OriginalNov 2, 2026
RLI Insurance GroupRLI Insurance Company51OriginalAug 18, 2026

View all 37 carrier groups

How the largest insurers handle WC 00 04 03

Groups among the largest workers compensation insurers that filed WC 00 04 03 or their own version in the past five years.

States

Number of filings that include WC 00 04 03 in each state, Nov 2021 to Nov 2026. Darker states have more filings.

Tennessee: 1 filingTN1Alabama: 1 filingAL1Florida: 0 filingsFLGeorgia: 3 filingsGA3Oklahoma: 2 filingsOK2South Carolina: 5 filingsSC5Arkansas: 0 filingsARMissouri: 1 filingMO1Indiana: 1 filingIN1Louisiana: 2 filingsLA2Ohio: 0 filingsOHWisconsin: 0 filingsWITexas: 0 filingsTXKentucky: 2 filingsKY2Iowa: 0 filingsIAKansas: 1 filingKS1Mississippi: 1 filingMS1North Carolina: 0 filingsNCNebraska: 0 filingsNESouth Dakota: 1 filingSD1Montana: 2 filingsMT2New Hampshire: 0 filingsNHVirginia: 0 filingsVAArizona: 2 filingsAZ2Pennsylvania: 1 filingPA1Rhode Island: 0 filingsRIMichigan: 2 filingsMI2Alaska: 0 filingsAKDistrict of Columbia: 0 filingsDCIdaho: 1 filingID1Maryland: 0 filingsMDWest Virginia: 0 filingsWVUtah: 1 filingUT1Wyoming: 2 filingsWY2Delaware: 0 filingsDENew Mexico: 2 filingsNM2Colorado: 114 filingsCO114Connecticut: 1 filingCT1Maine: 0 filingsMENorth Dakota: 1 filingND1Illinois: 2 filingsIL2Minnesota: 0 filingsMNNew Jersey: 0 filingsNJNew York: 0 filingsNYMassachusetts: 0 filingsMAWashington: 1 filingWA1Oregon: 1 filingOR1Vermont: 0 filingsVTCalifornia: 1 filingCA1Nevada: 1 filingNV1Hawaii: 5 filingsHI5
FewerMore filingsNone

Often filed with

Standard-style form numbers that appear in the same filings most often.

  • WC 00 03 08Partners, Officers and Others Exclusion Endorsement156 filings
  • WC 00 03 10Sole Proprietors, Partners, Officers and Others Coverage Endorsement155 filings
  • WC 00 03 13Waiver of Our Right to Recover From Others Endorsement155 filings
  • WC 00 04 21Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement154 filings
  • WC 00 04 22Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement154 filings
  • WC 00 04 06Premium Discount Endorsement153 filings
  • WC 00 04 14Notification of Change in Ownership Endorsement151 filings
  • WC 00 00 00Workers Compensation and Employers Liability Insurance Policy150 filings
  • WC 00 03 01Alternate Employer Endorsement150 filings
  • WC 00 04 12Contingent Experience Rating Modification Factor Endorsement150 filings

Recent filings

Latest filings that include this form number. Filed copies open in FilingFocus.

SubmittedCompanyStateEditionsTracking number
Nov 2, 2026Illinois Casualty CompanyOROriginalILCC-135079829
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

View all 161 filings

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