What it does
WC 00 03 10 (Ed. 4-84) records that an election was made by or on behalf of each person in its Schedule to be subject to the workers compensation law of the state shown, and that the premium basis includes their remuneration. The Schedule has lines for sole proprietor, partners, officers and others, each tied to a state.
Who needs it
Owners who are excluded from the definition of employee by default under a state's act and want coverage. Typical reasons:
- A general contractor or project owner requires every subcontractor's owners to be covered, or will not accept a certificate showing no coverage for working owners.
- The owner works in the field and wants statutory medical and wage benefits for his or her own injuries.
- The insured wants to avoid audit charges or disputes over owners who perform covered work.
Key provisions
- Individuals may be named or described (all partners, all executive officers except the president, each person named in Item 4), but only when that is appropriate under the state act.
- The election is state-specific; list each state where the owner works.
Quoting and selling notes
- The premium basis includes the included owners' remuneration. Ask the carrier which state manual rule sets the amount reported for each owner before quoting.
- Check whether the state requires an election form filed with the agency or carrier.
- For one-person contractors, coverage with no employees still generates a minimum premium; compare that with the cost of losing work over certificate requirements.
Related forms
Exclusion endorsement WC 00 03 08; Information Page WC 00 00 01.
