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Manuals

Servicing Carrier Performance Standards

Required Assigned Risk Endorsements

The following endorsements must be attached to every Michigan Assigned Risk policy.

All assigned risk endorsements can be found in the MWCPF Basic Manual, Part Four - Policy Forms and Endorsements

Endorsement Form
Endorsement Name
WC 00 03 26 A
Residual Market Limited Other States Insurance Endorsement
WC 21 03 03 A
Michigan Notice to Policyholder Endorsement
WC 21 03 04
Michigan Law Endorsement
WC 21 03 05 A
Michigan Workers Compensation Placement Facility Endorsement
WC 21 04 02 B (Expires 12/31/20)
Michigan Terrorism Risk Insurance Program Reauthorization Act Endorsement
WC 21 04 02 C (Effective 1/1/21)
Michigan Terrorism Risk Insurance Program Reauthorization Act Endorsement

 

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