23-24_WC_WOS.pdf

This document is a Workers Compensation and Employers Liability Insurance Policy Endorsement (Form WC 00 03 13) with a specific Waiver of Right to Recover from Others Endorsement. The policy covers multiple states, including AL, AR, AZ, CA, CO, CT, FL, GA, IL, IN, KS, LA, MA, MD, ME, MI, MN, MO, MT, NC, NV, NY, OR, PA, RI, SC, SD, TN, VA, VT, and WV. The endorsement is issued by Sentry Insurance Company and dated 05/02/2023.

The endorsement provides a waiver mechanism that allows the insured to agree by written contract not to pursue recovery of payments from specific persons or organizations for work-related injuries prior to a loss. This waiver applies only to the extent of work performed under a written contract requiring such an agreement. The document does not specify specific goods, services, or contract values, but instead outlines the insurance company's terms for limiting subrogation rights in workers' compensation claims across the listed states.