Wc 00 03 13 PDF Details

The WC 00 03 13 form plays a critical role within the framework of workers compensation and employers liability insurance policies, addressing the waiver of the insurer's right to recover from others. This document specifies that the insurer, while typically holding the right to pursue reimbursement from any party liable for an employee's injury, will not exercise this right against the entities named in the policy's schedule. This waiver is contingent upon the policyholder's adherence to a contractual obligation requiring them to obtain such an agreement from the insurer, underscoring the importance of contractual compliance in managing insurance matters. The endorsement, which alters the terms of the attached policy, becomes effective upon issuance unless stated otherwise, and requires detailed information if issued after the policy's preparation. Beyond its technical aspects, the form embodies a negotiation tool that can influence contractual relationships, insurance claims, and financial liabilities, reflecting its significance for businesses navigating the complexities of workers compensation and employer liability scenarios.

QuestionAnswer
Form NameWc 00 03 13
Form Length1 pages
Fillable?Yes
Fillable fields6
Avg. time to fill out1 min 27 sec
Other namescompensation workers subrogation of waiver, workers comp waiver of subrogation, wc 00 03 13, wc000313

Form Preview Example

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY

WC 00 03 13

(Ed. 4-84)

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)

This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

Schedule

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Endorsement

Effective Policy No.

Endorsement No.

Insured

 

Premium

Insurance Company

Countersigned by___________________________________________

WC 00 03 13

(Ed. 4-84)

© 1983 National Council on Compensation Insurance.

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workers compensation waiver of subrogation endorsement gaps to complete

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