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Policy Forms

The ICRB files all standard forms with the IDOI on behalf of all members for their use.;

The Indiana Bureau files all standard forms (policy, endorsement, cancellation) with the Department of Insurance on behalf of the ICRB members for the members use. This is accomplished by filing the NCCI Forms Manual of Workers Compensation and Employers Liability Insurance Manual. ICRB needs one sample copy of each carrier's policy forms on file. If a carrier wants to use a non-standard form, it must file it for approval with the Department of Insurance and send a copy to ICRB.

The attacehed document, New Simplified 1984 WC & EL Insurance Policy file contains an explanation of the numbering scheme for the standard workers compensation policy and endorsements. For instance, the information page is identified as "WC 00 00 01."

The WC & EL policy went through revisions  on 04/01/84 and 04/01/92. 
 
For the 04/01/84 change, the ICRB issued a summary of circulars on the filing. Prior to 1984, it appears the previous change to the policy was in 1954.
 
For the 04/01/92 change, NCCI printed a booklet titled “The Guide to Workers Compensation and Employers Liability Policy” that presented the changes in underlined text.

Related Files

The material in this document has been prepared and shared for informational purposes only and should not be relied upon as legal advice on any particular situation.