This workers compensation policy endorsement is attached to a work comp policy when any business, business owner or employer performs work operations in more than one state. This endorsement is also used to show the rate and premium developed for the other states as shown in the policy documents. This endorsement applies a residual market differential to the estimated standard premium according to the individual state rate pages.
This work comp policy endorsement explains the premium a policyholder pays for workers compensation insurance coverage as it applies to each state that is being shown on the forms schedule. The schedule is a specific section and it makes up part of this endorsement.
WC 00 04 11 is the form number which can be found indicated on a policy when this endorsement is used or attached to a workers comp policy. As with all policy endorsements this form changes the basic policy contract and plays an important role in following the specific costs related to each and every individual state listed on the endorsement. As with other workers comp policy endorsements this endorsement may not be used by all states. It is important to review each states rules in order to verify the accepted use by the state governing authority of this endorsement.