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Worker comp waiver form

Wc 00 03 13 2026

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The document outlines a Waiver of Right to Recover from Others Endorsement related to Workers Compensation and Employers Liability Insurance. It specifies that the insurance provider will not pursue recovery of payments from individuals or organizations listed in a designated schedule, provided that the insured performs work under a written contract requiring this waiver.

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Click ‘Get Form’ to open the wc 00 03 13 endorsement in the editor.
Begin by filling out the 'Insured' section with the name of the individual or organization covered under this policy.
Next, enter the 'Insurance Company' name that is providing coverage for this endorsement.
Fill in the 'Effective Policy No.' and 'Endorsement No.' fields to ensure proper identification of your policy.
Complete the 'Premium' field with the relevant amount associated with this endorsement.
Finally, ensure that you sign in the designated area labeled 'Countersigned by' to validate this endorsement.

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