FIS Waiver of Right to Recover WC.pdf
PDF 328 KB Posted
- Attached to
- Master Agreement AZ|CTR060124
- Contract number
- CTR060124
- Issued by
- Arizona
About this file
This document is a Workers Compensation and Employers Liability Insurance Policy Endorsement issued by American Casualty Company of Reading, Pennsylvania, with a policy effective date of 01/01/2023. The endorsement specifically addresses a "Waiver of Right to Recover from Others" and applies to work performed under written contracts, with a particular note about limitations for work performed in Missouri related to construction classifications.
The endorsement details the insurance company's agreement to waive its right to recover payments from certain persons or organizations named in the Schedule, contingent upon the insured performing work under a written contract requiring such a waiver. The premium charge for this endorsement is reflected in the Schedule of Operations, and the policy maintains all other original terms and conditions. The document is a standard form (WC 00 03 13) copyrighted by the National Council on Compensation Insurance in 1983, and it provides a mechanism for limiting subrogation rights in specific contractual scenarios.
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Text version
Workers Compensation And Employers Liability Insurance
Policy Endorsement
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual.
Schedule
Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover from under a written contract or agreement.
The premium charge for the endorsement is reflected in the Schedule of Operations.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below.
WC 7 36257976
Endorsement No: 40; Page: 1 of 1 Policy Page: 257 of 396 Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, Chicago, IL 60606
Form No: WC 00 03 13 (04-1984) Endorsement Effective Date:
Policy No:
Policy Effective Date: 01/01/2023Endorsement Expiration Date:
Copyright 1983 National Council on Compensation Insurance.
File details come from the government source that posted it. Updated .