Coverage description
A National Council on Compensation Insurance (NCCI) standard form. It requires you to report any change in ownership to the insurer in writing within 90 days, because the change can alter the experience rating modification factor used to set your premium.
Updated
What the form says
Key clauses from edition A, the latest revision, quoted as filed.
“You must report any change in ownership to us in writing within 90 days of the date of the change.”
WC 00 04 14 A
The reporting deadline. Notice must be in writing and must reach the insurer within 90 days, counted from the date the ownership change takes place.
“Change in ownership includes sales, purchases, other transfers, mergers, consolidations, dissolutions, formations of a new entity”
WC 00 04 14 A
What counts as a change in ownership. The definition reaches beyond sales and purchases to mergers, consolidations, dissolutions and newly formed entities, plus any other change the applicable experience rating plan provides for.
“regardless of whether the change is reported within 90 days of such change, may result in revision of the experience rating modification factor”
WC 00 04 14 A · New in this edition
What an unreported change can lead to. An ownership change that goes unreported can lead to a revised modification factor, which is the factor used to determine your premium. Revision A says this applies regardless of whether the change is reported within the 90 days; the original tied it to failing to report within that period.
“This reporting requirement applies regardless of whether an experience rating modification is currently applicable to this policy.”
WC 00 04 14 A · New in this edition
When no experience modification applies yet. The duty to report holds even when the policy carries no modification factor today. The form also states that experience rating is mandatory for all eligible insureds.
How the form has changed
2 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 editionTies a possible revision of the experience rating modification factor to any failure to report an ownership change, regardless of whether the change is reported within 90 days, where the original tied it to failing to report within that period.
Original edition
“Failure to report such changes within this period may result in revision”
Edition A
“regardless of whether the change is reported within 90 days of such change”
Adds that the reporting requirement applies whether or not an experience rating modification currently applies to the policy.
Original edition
Not in this edition
Edition A
“This reporting requirement applies regardless of whether an experience rating modification is currently applicable”
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, 47 companies filed edition A and 11 companies filed the original edition.
- WC 00 04 22 (Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement) is filed alongside it most often, in 159 of the same filings (99%).
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 14, out of 33 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 | 21 | 2 | A | Jun 25, 2026 |
| Nationwide Corporation Group9 group companies filed it, led by AMCO Insurance Company and Crestbrook Insurance Company | 20 | 1 | A | Jun 30, 2026 |
| United Fire & CAS GroupUnited Fire and Casualty Company | 15 | 12 | A | May 4, 2026 |
| AXA Insurance Group5 group companies filed it, led by Greenwich Insurance Company and XL Insurance America, Inc. | 6 | 2 | OriginalA | Jun 23, 2026 |
| Acuity, A Mutual Insurance Company | 6 | 2 | OriginalA | Jul 1, 2026 |
| Tokio Marine Holdings Incorporated Group2 group companies filed it, led by Safety First Insurance Company and Safety National Casualty Corporation | 6 | 2 | A | May 14, 2025 |
| Donegal Group3 group companies filed it, led by Donegal Mutual Insurance Company and Mountain States Indemnity Company | 5 | 1 | A | Apr 27, 2026 |
| Intact Financial Group3 group companies filed it, led by Atlantic Specialty Insurance Company and OBI America Insurance Company | 5 | 1 | A | Jun 24, 2026 |
| Mutual Capital Group Incorporated GroupIllinois Casualty Company | 5 | 5 | A | Nov 2, 2026 |
| RLI Insurance GroupRLI Insurance Company | 5 | 1 | A | Aug 18, 2026 |
States
Number of filings that include WC 00 04 14 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 04 22Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement159 filings
- WC 00 04 21Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement158 filings
- WC 00 04 19Premium Due Date Endorsement152 filings
- WC 00 04 03Experience Rating Modification Factor Endorsement151 filings
- WC 00 00 00Workers Compensation and Employers Liability Insurance Policy150 filings
- WC 00 03 08Partners, Officers and Others Exclusion Endorsement150 filings
- WC 00 03 10Sole Proprietors, Partners, Officers and Others Coverage Endorsement150 filings
- WC 00 03 13Waiver of Our Right to Recover From Others Endorsement149 filings
- WC 00 04 12Contingent Experience Rating Modification Factor Endorsement146 filings
- WC 00 03 02Designated Workplaces Exclusion Endorsement145 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 | A | ILCC-135079829 |
| Sep 16, 2026 | ZNAT Insurance Company | CT | Original | ZICO-135090521 |
| Aug 18, 2026 | RLI Insurance Company | CO | A | RLSC-135057018 |
| Jul 1, 2026 | Acuity, A Mutual Insurance Company | CO | A | ACUT-134982793 |
| Jun 30, 2026 | American Casualty Company of Reading, Pennsylvaniaand 5 more | CO | A | CNAB-135003197 |
| Jun 30, 2026 | Crestbrook Insurance Companyand 1 more | CO | A | NWPP-135003409 |
| Jun 30, 2026 | National Casualty Company | CO | A | NWPP-135004216 |
| Jun 25, 2026 | American National Property And Casualty Company | CO | A | ANPC-134996042 |
| Jun 24, 2026 | Atlantic Specialty Insurance Companyand 2 more | CO | A | 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 | A | 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 04 04 Pending Rate Change Endorsement