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NCCI endorsement · workers compensation

WC 00 05 11 Retrospective Premium Endorsement Short Form

Filings
86
latest Sep 16, 2026
Filing companies
69
24 carrier groups
States
13
Latest edition
Original
View PDFs

Coverage description

A National Council on Compensation Insurance (NCCI) standard form. It sets this policy's premium by the Retrospective Premium Endorsement attached to another policy, named by its policy number, instead of attaching the full endorsement again.

Updated

What the form says

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

“The premium for this policy will be determined by the Retrospective Premium Endorsement”

WC 00 05 11

Where this policy's premium comes from. This policy carries no retrospective terms of its own. Its premium is calculated under the Retrospective Premium Endorsement that is part of another policy.

“forming a part of policy number”

WC 00 05 11

Which policy holds the full endorsement. The blank names the policy that carries the full Retrospective Premium Endorsement, which ties this policy into the same retrospective plan.

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
OriginalLatest866913Jan 2022 to Sep 2026View PDF

What the filings show

  • Edition in use: in the past 12 months, 32 companies filed the original edition.
  • WC 00 03 04 (Insurance Company as Insured Endorsement) is filed alongside it most often, in 84 of the same filings (98%).

Filed under

Standard WC 68WC 16Employers Liability WC 2

Data from admitted P&C filings with state insurance departments, submitted Nov 2021 to Sep 2026, excluding withdrawn and rejected filings.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 05 11, out of 24 in total.

CarrierFilingsStatesEditions, most filed firstLast filed
Brookfield Wealth Solutions Group4 group companies filed it, led by Argonaut Insurance Company and Argonaut-Midwest Insurance Company191OriginalJun 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
RLI Insurance GroupRLI Insurance Company51OriginalAug 18, 2026
Sompo Group2 group companies filed it, led by Sompo America Fire and Marine Insurance Company and Sompo America Insurance Company51OriginalJun 15, 2026
THE Hanover Insurance Group6 group companies filed it, led by Allmerica Financial Alliance Insurance Company and Allmerica Financial Benefit Insurance Company51OriginalJun 23, 2026
Arch Insurance Group2 group companies filed it, led by Arch Indemnity Insurance Company and Arch Insurance Company41OriginalApr 8, 2026
Louisiana Workers Compensation GroupPrescient National Insurance Company41OriginalJul 2, 2025
American Financial Group4 group companies filed it, led by Great American Alliance Insurance Company and Great American Assurance Company31OriginalJun 11, 2024

View all 24 carrier groups

How the largest insurers handle WC 00 05 11

Groups among the largest workers compensation insurers that filed WC 00 05 11 or their own version in the past five years.

States

Number of filings that include WC 00 05 11 in each state, Nov 2021 to Sep 2026. Darker states have more filings.

Tennessee: 0 filingsTNAlabama: 0 filingsALFlorida: 0 filingsFLGeorgia: 0 filingsGAOklahoma: 1 filingOK1South Carolina: 2 filingsSC2Arkansas: 0 filingsARMissouri: 0 filingsMOIndiana: 0 filingsINLouisiana: 0 filingsLAOhio: 0 filingsOHWisconsin: 0 filingsWITexas: 0 filingsTXKentucky: 1 filingKY1Iowa: 0 filingsIAKansas: 0 filingsKSMississippi: 0 filingsMSNorth Carolina: 0 filingsNCNebraska: 0 filingsNESouth Dakota: 0 filingsSDMontana: 0 filingsMTNew Hampshire: 0 filingsNHVirginia: 0 filingsVAArizona: 1 filingAZ1Pennsylvania: 1 filingPA1Rhode Island: 0 filingsRIMichigan: 1 filingMI1Alaska: 0 filingsAKDistrict of Columbia: 0 filingsDCIdaho: 0 filingsIDMaryland: 0 filingsMDWest Virginia: 0 filingsWVUtah: 0 filingsUTWyoming: 4 filingsWY4Delaware: 0 filingsDENew Mexico: 0 filingsNMColorado: 68 filingsCO68Connecticut: 1 filingCT1Maine: 0 filingsMENorth Dakota: 2 filingsND2Illinois: 0 filingsILMinnesota: 0 filingsMNNew Jersey: 0 filingsNJNew York: 1 filingNY1Massachusetts: 0 filingsMAWashington: 2 filingsWA2Oregon: 0 filingsORVermont: 0 filingsVTCalifornia: 0 filingsCANevada: 0 filingsNVHawaii: 1 filingHI1
FewerMore filingsNone

Often filed with

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

  • WC 00 03 04Insurance Company as Insured Endorsement84 filings
  • WC 00 03 05Joint Venture as Insured Endorsement84 filings
  • WC 00 01 06Longshoremen's and Harbor Workers' Compensation Act Coverage Endorsement83 filings
  • WC 00 03 09Rural Utilities Service Endorsement83 filings
  • WC 00 03 15Domestic and Agricultural Workers Exclusion Endorsement83 filings
  • WC 00 05 08Retrospective Premium Endorsement Aviation Exclusion83 filings
  • WC 00 03 01Alternate Employer Endorsement82 filings
  • WC 00 03 08Partners, Officers and Others Exclusion Endorsement82 filings
  • WC 00 04 06Premium Discount Endorsement82 filings
  • WC 00 05 03Retrospective Rating Plan Premium Endorsement One-Year Plan82 filings

Recent filings

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

SubmittedCompanyStateEditionsTracking number
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 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
Jun 4, 2026Argonaut-Midwest Insurance CompanyCOOriginalARGN-134974739
Jun 4, 2026Argonaut Insurance CompanyCOOriginalARGN-134974742
Jun 4, 2026Rockwood Casualty Insurance CompanyCOOriginalARGN-134974764
May 27, 2026Alaska National Insurance CompanySCOriginalALNI-134962436
May 27, 2026CopperPoint Casualty Insurance Companyand 1 moreSCOriginalCOPP-134964112

View all 86 filings

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