WC & EL / PART FOUR / PART FOUR

The Standard Workers’ Compensation and Employers’ Liability Insurance Policy, the New York Volunteer Ambulance Workers’ Benefit Law Policy and the New York Volunteer Firefighters’ Benefit Law Policy are provided in this section. Also included are the Information Page Notes.

The endorsements which appear on the following pages are for use in connection with the standard provisions of the Workers’ Compensation and Employers’ Liability Policy with the following exceptions:

All endorsements have a unique identifying number.  The numbering standard format is such that the numbers provide the user with information as to the type and purpose of the endorsement.  The layout is made up of eight or nine characters depending on the version of the endorsement.

1. Line of Insurance – WC

   The first two characters are WC. This means the endorsement applies to workers’ compensation and employers’ liability insurance.

2. National/State

   The next two characters detail whether the endorsement is a nationwide or state form.

   1. A nationwide endorsement carries the number “00”and is promulgated by the National Council on Compensation Insurance (NCCI).

   2. A state specific endorsement carries the state code for the state in which they are effective.
      For example: The form specific to New York has “31” as the second set of characters.

3. Type

   The third set of characters identifies the specific type of endorsement, i.e., premium as opposed to coverage.  The number and types are as follows:

   01 – Federal Coverages and Exclusions
   02 – Maritime Coverages and Exclusions
   03 – Other Coverages and Exclusions
   04 – Premium
   05 – Retrospective Premium
   06 – Miscellaneous

4. Sequence Number

   The fourth set of characters is the unique identifying number that differentiates an endorsement from others in the same series. A multipage endorsement will have only one number.

5. Version Identifier

   The last character identifies the version of the policy and each endorsement. The identifying number of the version of the policy and each endorsement that was in effect prior to the rule change creating the version identifier contains only alphabetic characters. The original printing of an endorsement effective after the rule change will also contain eight characters. Each subsequent version of the policy and endorsements will contain a ninth alphabetical character. This alphabetical character will sequentially identify each subsequent reprint of the policy and endorsements from A through Z.

   Rating Board approval is not required for carriers to use their own attachment clause, letterheads and/or form numbers. However, any deviation, modification of, or customization to the wording of any standard form, whether national or New York specific, requires submission to and approval by the Rating Board, in addition to filing with and obtaining approval from the New York State Department of Financial Services.

   No deviation from the text of any authorized endorsement shall be made unless permitted by the explanatory notes thereunder.