These endorsements have been filed by the Pennsylvania Compensation Rating Bureau (PCRB) on behalf of its membership and have been approved by the Pennsylvania Insurance Department for use. These endorsements can be used by member carriers of the PCRB without further filing requirements with the Insurance Department.
Pennsylvania Approved Endorsements
| 90-Day Reporting Requirement – Notification Change of Ownership | WC 00 04 14 A |
| Alternate Employer Endorsement | WC 00 03 01 A |
| Anniversary Rating Date Endorsement (Eliminated 05/01/17) | WC 00 04 02 |
| Catastrophe (Other Than Certified Acts of Terrorism) | WC 00 04 21 E |
| Contingent Experience Rating Modification Endorsement | WC 00 04 12 |
| Defense Base Act Coverage Endorsement | WC 00 01 01 A |
| Domestic and Agricultural Workers Exclusion Endorsement | WC 00 03 15 |
| Employers Liability Coverage Endorsement | WC 00 03 03 C |
| Experience Rating Modification Factor Endorsement | WC 00 04 03 |
| Experience Rating Modification Factor Revision Endorsement (Effective 05/01/17) | WC 00 04 25 |
| Federal Mine Safety and Health Act Coverage Endorsement | WC 00 01 02 B |
| Federal Employers Liability Act Coverage Endorsement | WC 00 01 04 A |
| Insurance Company as Insured Endorsement | WC 00 03 04 |
| Joint Venture as Insured Endorsement | WC 00 03 05 |
| Longshore & Harbor Workers' Compensation Act Coverage Endorsement | WC 00 01 06 A |
| Maritime Coverage Endorsement | WC 00 02 01 B |
| Migrant and Seasonal Agricultural Workers Protection Act Coverage Endorsement | WC 00 01 11 |
| Nonappropriated Fund Instrumentalities Act Coverage Endorsement | WC 00 01 08 A |
| Outer Continental Shelf Lands Act Coverage Endorsement | WC 00 01 09 C |
| Pending Rate Change Endorsement | WC 00 04 04 |
| Policy Information Page Endorsement | WC 89 06 00 A |
| Policy Period Endorsement | WC 00 04 05 |
| Premium Discount Endorsement | WC 00 04 06 |
| Premium Due Date Endorsement | WC 00 04 19 |
| Professional Employer Organization (PEO) Extension Endorsement | WC 00 03 20 B |
| Professional Employer Organization (PEO) Exclusion Endorsement | WC 00 03 21 A |
| Professional Employer Organization (PEO) Client Exclusion Endorsement | WC 00 03 22 A |
| Rate Change Endorsement | WC 00 04 07 |
| Rural Electrification Administration Endorsement | WC 00 03 09 |
| Sole Proprietors, Partners, Officers and Others Coverage Endorsement | WC 00 03 10 |
| Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement | WC 00 04 22 C |
| Voluntary Compensation and Employers Liability Coverage Endorsement | WC 00 03 11 A |
| Voluntary Compensation Maritime Coverage Endorsement | WC 00 02 03 |
| Waiver of Our Right to Recover from Others Endorsement | WC 00 03 13 |
Pennsylvania Specific Endorsements
| Audit Noncompliance Charge Endorsement | WC 37 04 01 |
| Certified Safety Committee Endorsement | WC 37 04 04 C |
| Church Endorsement – Pennsylvania | WC 37 03 01 |
| Deductible Endorsement | WC 37 04 03 |
| Employer Assessment Endorsement | WC 37 06 04 |
| Exclusion of Employees Endorsement – Pennsylvania | WC 37 03 03 |
| Exclusion of Executive Officers Endorsement | WC 37 03 10 C |
| Pennsylvania Act 86-1986 Endorsement | WC 37 06 03 A |
| Pennsylvania Construction Classifications Premium Adjustment Endorsement | WC 37 04 02 |
| Pennsylvania Merit Rating Plan Endorsement | WC 37 04 05 |
| Pennsylvania Multiple Coordinated Policy Endorsement | WC 37 03 11 |
| Pennsylvania Notice | WC 37 06 02 |
| Policemen/Firemen – Counties, Cities, Towns and Boroughs Endorsement-Pennsylvania | WC 37 03 02 |
| Principal as Additional Insured – Pennsylvania | WC 37 03 04 |
| Professional Association Act Endorsement – Pennsylvania | WC 37 03 05 |
| Real Estate Management Endorsement – Pennsylvania | WC 37 03 06 |
| Religious Institution Endorsement – Pennsylvania | WC 37 03 07 |
| Special Pennsylvania Endorsement – Inspections of Manual | WC 37 06 01 |
| Spouse of Insured Endorsement – Pennsylvania | WC 37 03 08 |
| Statutory Employer Endorsement – Pennsylvania | WC 37 03 09 A |