Coverage description
A National Council on Compensation Insurance (NCCI) standard form. It divides the policy period shown on the Information Page into consecutive periods listed in the schedule, with the insurer's manuals and every policy provision applying separately to each period.
Updated
What the form says
Key clauses from the original edition, which has not been revised, quoted as filed.
“The policy period shown in Item 2 of the Information Page consists of the consecutive periods shown in the Schedule.”
WC 00 04 05
How the policy period is divided. Item 2 of the Information Page shows the overall period. The schedule breaks it into back-to-back periods, each with a from and to date and a 12:01 a.m. time.
“Our Manuals and all provisions of the policy apply separately to each period.”
WC 00 04 05
What applies to each period on its own. The insurer's rating manuals and all of the policy's provisions apply period by period, so each scheduled period is treated separately rather than as one continuous term.
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.
| Edition | Filings | Companies | States | Filed | Document |
|---|---|---|---|---|---|
| OriginalLatest | 107 | 69 | 14 | Jan 2022 to Sep 2026 | View PDF |
What the filings show
- Edition in use: in the past 12 months, 42 companies filed the original edition.
- WC 00 03 08 (Partners, Officers and Others Exclusion Endorsement) is filed alongside it most often, in 104 of the same filings (97%).
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Data from admitted P&C filings with state insurance departments, submitted Nov 2021 to Sep 2026, excluding withdrawn and rejected filings.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 04 05, out of 26 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 |
| Nationwide Corporation Group3 group companies filed it, led by Crestbrook Insurance Company and National Casualty Company | 10 | 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 |
| 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 |
| Acuity, A Mutual Insurance Company | 5 | 1 | Original | Jul 1, 2026 |
| Arch Insurance Group3 group companies filed it, led by Arch Indemnity Insurance Company and Arch Insurance Company | 5 | 2 | Original | Apr 8, 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 |
States
Number of filings that include WC 00 04 05 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 08Partners, Officers and Others Exclusion Endorsement104 filings
- WC 00 03 10Sole Proprietors, Partners, Officers and Others Coverage Endorsement103 filings
- WC 00 04 06Premium Discount Endorsement103 filings
- WC 00 04 12Contingent Experience Rating Endorsement103 filings
- WC 00 04 03Experience Rating Modification Factor Endorsement102 filings
- WC 00 04 04Pending Rate Change Endorsement102 filings
- WC 00 03 01Alternate Employer Endorsement101 filings
- WC 00 03 05Joint Venture as Insured Endorsement101 filings
- WC 00 03 02Designated Workplaces Exclusion Endorsement100 filings
- WC 00 04 19Premium Due Date Endorsement100 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 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 10, 2026 | 21st Century North America Insurance Companyand 4 more | GA | Original | FARM-134836159 |
| Jun 4, 2026 | Argonaut-Midwest Insurance Company | CO | Original | ARGN-134974739 |
| Jun 4, 2026 | Argonaut Insurance Company | CO | Original | ARGN-134974742 |
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