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Mandatory Endorsements

The following endorsements must be attached to every Massachusetts Assigned Risk Pool policy.  To view the Massachusetts endorsements, click on the appropriate link.

WC 00 04 14 Notification of Change in Ownership Endorsement
WC 00 04 22 B Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement  - effective 01/01/2015
WC 20 03 01 Massachusetts Limits of Liability Endorsement
WC 20 03 02 A Massachusetts Assessment Charge
WC 20 03 03 D (pdf)
WC 20 03 03 D (word)
Massachusetts Notice to Policyholders' Endorsement
WC 20 03 06 B (pdf)
WC 20 03 06 B (word)
Massachusetts Limited Other States Benefit Endorsement
WC 20 03 07 Massachusetts Assigned Risk Pool Eligibility Endorsement
WC 20 04 05 Massachusetts Premium Due Date Endorsement
WC 20 06 01 A Massachusetts Cancellation Endorsement
WC 20 06 04 Massachusetts Policy Definition Endorsement

Resources

Mandatory Endorsements

NCCI's Servicing Carrier Reference Guide

Notices to Pool Carriers

Paid Loss Ratio Incentive Program

Performance Standards

Pool Procedures - Existing Policies

The Workers' Compensation Rating and Inspection Bureau of Massachusetts
101 Arch Street, 5th Floor
Boston, MA 02110