Carrier Forms

Complete and submit to file unit statistical data directly with WCRB

Standard endorsements accepted in Wisconsin

Listing of endorsements not accepted in Wisconsin

Replace the existing Authorizing Officer for your organization

Replace the existing Group Administrator for your organization

Complete to establish a WCRB website membership

User Guide for WCRB website members and a listing of products afforded to each membership level

Wisconsin Supplementary Non-Election Form

Wisconsin Supplementary Election of Coverage Form

Wisconsin Supplementary Limited Other States Coverage Request

Effective July 1, 2024, the Wisconsin Workers' Compensation Insurance Pool will no longer be accepting hard copy applications. Applications to the pool will only be accepted electronically via the Online Assigned Risk (OAR) member product. For more information on OAR, click here or contact our Pool Team at oar@wcrb.org or call 262-796-4592

WCPAP Premium Credit Factor Online Application

WCPAP Carrier Audit Form

Additional Remarks Schedule

Workers Compensation Application

Worker's Compensation and Employers Liability Insurance Policy language

Worker's Compensation and Employers Liability Insurance Policy information page

General Information Page Notes

Information Page Notes

Specific Excess Workers Compensation and Employers Liability Policy

Terrorism Risk Insurance Program Reauthorization Act Disclosure

Excess Policy for Self Insured

Designated Workplaces Exclusion Endorsement

Specific Excess and Aggregate Excess

Excess Voluntary Compensation and Employers Liability Coverage Endorsement

Cancellation Form

Amendatory Endorsement

Reporting of Data on Claims

Catastrophe Premium Endorsement

Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement

Excess Workers Compensation & Employers Liability Coverage Form

Stop Gap Insurance Endorsement

Maritime Coverage Endorsement