Coverage description
A National Council on Compensation Insurance (NCCI) standard form. It tells the insured that a rate change filing is pending with the regulator and that, if different rates result, the insurer will issue an endorsement showing the new rates and when they take effect.
Updated
What the form says
Key clauses from the original edition, which has not been revised, quoted as filed.
“A rate change filing is being considered by the proper regulatory authority.”
WC 00 04 04
Why the endorsement is attached. It is used when rates for a state on the policy are under regulatory review when the policy is written, so the rates shown may not be final.
“If it does, we will issue an endorsement to show the new rates and their effective date.”
WC 00 04 04
How new rates reach the policy. If the pending filing produces different rates, a later endorsement puts them on the policy and states the date they apply from.
“this endorsement applies only in the state shown in the Schedule”
WC 00 04 04
Which state it applies to. On a single state policy it applies to that state. On a multistate policy it applies only to the state entered in the schedule.
How the form has changed
Filed copies carry the 4-84 edition, and there is no lettered NCCI revision of this endorsement to compare.
Editions
Edition dates as filed, newest first. Filing counts include every state submission that lists the edition.
| Edition | Filings | Companies | States | Filed | Document |
|---|---|---|---|---|---|
| OriginalLatest | 161 | 99 | 25 | Dec 2021 to Nov 2026 | View PDF |
What the filings show
- Edition in use: in the past 12 months, 63 companies filed the original edition.
- WC 00 03 08 (Partners, Officers and Others Exclusion Endorsement) is filed alongside it most often, in 148 of the same filings (92%).
Filed under
Data from admitted P&C filings with state insurance departments, submitted Nov 2021 to Nov 2026, excluding withdrawn and rejected filings.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 04, out of 37 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 |
| United Fire & CAS GroupUnited Fire and Casualty Company | 11 | 8 | Original | May 4, 2026 |
| Copperpoint Group10 group companies filed it, led by CopperPoint Premier Insurance Company and Alaska National Insurance Company | 10 | 4 | Original | May 27, 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 |
| 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 |
| Mutual Capital Group Incorporated GroupIllinois Casualty Company | 5 | 5 | Original | Nov 2, 2026 |
| RLI Insurance GroupRLI Insurance Company | 5 | 1 | Original | Aug 18, 2026 |
How the largest insurers handle WC 00 04 04
Groups among the largest workers compensation insurers that filed WC 00 04 04 or their own version in the past five years.
- Amtrust Financial Services GroupUses WC 00 04 04 in 1 filing
States
Number of filings that include WC 00 04 04 in each state, Nov 2021 to Nov 2026. Darker states have more filings.
Often filed with
Standard-style form numbers that appear in the same filings most often.
- WC 00 03 08Partners, Officers and Others Exclusion Endorsement148 filings
- WC 00 03 13Waiver of Our Right to Recover From Others Endorsement145 filings
- WC 00 04 03Experience Rating Modification Factor Endorsement145 filings
- WC 00 04 06Premium Discount Endorsement145 filings
- WC 00 03 05Joint Venture as Insured Endorsement143 filings
- WC 00 03 10Sole Proprietors, Partners, Officers and Others Coverage Endorsement143 filings
- WC 00 03 01Alternate Employer Endorsement141 filings
- WC 00 04 21Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement141 filings
- WC 00 04 22Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement141 filings
- WC 00 00 00Workers Compensation and Employers Liability Insurance Policy140 filings
Recent filings
Latest filings that include this form number. Filed copies open in FilingFocus.
| Submitted | Company | State | Editions | Tracking number |
|---|---|---|---|---|
| Nov 2, 2026 | Illinois Casualty Company | OR | Original | ILCC-135079829 |
| 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 |
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 03 01 Alternate Employer Endorsement