mwcia circular 15-1667 - ncci item p-1412- terrorism risk ...the act limits our liability to you...

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Minnesota Workers’ Compensation Insurers Association, Inc. 7701 France Avenue South Suite 450 Minneapolis, MN 55435-3200 952.897.1737 PH 952.897.6495 FX www.mwcia.org February 24, 2015 ALL ASSOCIATION MEMBERS Circular Letter 15-1667 RE: NCCI Item P-1412─ Terrorism Risk Insurance Program Reauthorization Act of 2015 Endorsements The Minnesota Department of Commerce has approved the above filing to become effective, 12:01 a.m., January 1, 2015, for new, renewal, and outstanding policies issued on and after 12:01 a.m. on January 1, 2015. This item revises and withdraws endorsements in the Minnesota Forms Manual as a result of the recent enactment of the Terrorism Risk Insurance Program Reauthorization Act of 2015 (TRIPRA of 2015). The Terrorism Risk Insurance Act of 2002 (“TRIA” or the “Act”) was implemented as a result of the US Congress recognizing that terrorism is a catastrophe exposure that is real and significant for insurers of workerscompensation and other lines of insurance. It initially provided a temporary program under which the Federal government would share in the payment of insured losses caused by certain acts of terrorism. TRIA was scheduled to expire on December 31, 2005. It was renewed as the Terrorism Risk Insurance Extension Act (TRIEA) in 2005, and as the Terrorism Risk Insurance Program Reauthorization Act (TRIPRA) in 2007. MWCIA filed and adopted several national items that proposed the necessary miscellaneous values, rules, and policy forms to implement the original TRIA and each of its renewals Recognizing that terrorism is a catastrophe exposure that continues to be significant for insurers of workerscompensation and other lines of insurance, the US Congress enacted TRIPRA of 2015. The key provisions are as follows: The Act was extended for six years and will expire December 31, 2020 An act of terrorism must be certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States Beginning on January 1, 2016: The current 85% Federal share of compensation under the Terrorism Insurance Program (Program) decreases by one percentage point per calendar year until it is equal to 80% The current Program trigger for aggregate industry insured losses to exceed $100 million increases by $20 million per calendar year until it is equal to $200 million The current $27.5 billion insurance marketplace aggregate retention amount increases by $2 billion per calendar year, beginning in 2015, until it is equal to $37.5 billion, and is subject to further revision thereafter.

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Page 1: MWCIA Circular 15-1667 - NCCI Item P-1412- Terrorism Risk ...The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program

Minnesota Workers’ Compensation Insurers Association, Inc.

7701 France Avenue South Suite 450 Minneapolis, MN 55435-3200

952.897.1737 PH 952.897.6495 FX www.mwcia.org

February 24, 2015 ALL ASSOCIATION MEMBERS

Circular Letter 15-1667

RE: NCCI Item P-1412─ Terrorism Risk Insurance Program Reauthorization Act of

2015 Endorsements

The Minnesota Department of Commerce has approved the above filing to become effective, 12:01 a.m., January 1, 2015, for new, renewal, and outstanding policies issued on and after 12:01 a.m. on January 1, 2015. This item revises and withdraws endorsements in the Minnesota Forms Manual as a result of the recent enactment of the Terrorism Risk Insurance Program Reauthorization Act of 2015 (TRIPRA of 2015). The Terrorism Risk Insurance Act of 2002 (“TRIA” or the “Act”) was implemented as a result of the US Congress recognizing that terrorism is a catastrophe exposure that is real and significant for insurers of workers’ compensation and other lines of insurance. It initially provided a temporary program under which the Federal government would share in the payment of insured losses caused by certain acts of terrorism. TRIA was scheduled to expire on December 31, 2005. It was renewed as the Terrorism Risk Insurance Extension Act (TRIEA) in 2005, and as the Terrorism Risk Insurance Program Reauthorization Act (TRIPRA) in 2007. MWCIA filed and adopted several national items that proposed the necessary miscellaneous values, rules, and policy forms to implement the original TRIA and each of its renewals Recognizing that terrorism is a catastrophe exposure that continues to be significant for insurers of workers’ compensation and other lines of insurance, the US Congress enacted TRIPRA of 2015. The key provisions are as follows:

The Act was extended for six years and will expire December 31, 2020

An act of terrorism must be certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States

Beginning on January 1, 2016:

The current 85% Federal share of compensation under the Terrorism Insurance Program (Program) decreases by one percentage point per calendar year until it is equal to 80%

The current Program trigger for aggregate industry insured losses to exceed $100 million increases by $20 million per calendar year until it is equal to $200 million

The current $27.5 billion insurance marketplace aggregate retention amount increases by $2 billion per calendar year, beginning in 2015, until it is equal to $37.5 billion, and is subject to further revision thereafter.

Page 2: MWCIA Circular 15-1667 - NCCI Item P-1412- Terrorism Risk ...The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program

To implement the changes as a result of the enactment of TRIPRA of 2015, the following revisions will be made to the Minnesota Forms Manual:

1. The Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 A) must be revised to:

Update the TRIPRA references to TRIPRA of 2015

Revise the definitions to conform to TRIPRA of 2015

Revise the Insurer Deductible provisions

Revise the Program trigger amounts and the Federal share of compensation provisions 2. The Notification Endorsement of Pending Law Change to Terrorism Risk Insurance Program Reauthorization Act of 2007 (WC 00 01 14) must be withdrawn. The purpose of this endorsement was to notify policyholders of the impending expiration of TRIPRA. However, with the enactment of TRIPRA of 2015, this endorsement is no longer needed. Exhibits 1, 3, and 3A illustrate all necessary changes to the Minnesota Forms Manual. As in past filings, strikethroughs indicate deleted text and underlining indicates new or added text. A copy of National Council’s original filing memorandum is also included. Please direct any questions you may have concerning this item to MWCIA’s Underwriting staff at 952.897.1737 (Option 1) or via email at [email protected]. A NOTICE TO MEMBERSHIP: MWCIA would like to remind our membership who have filed a Limited Power of Attorney with the Minnesota Department of Commerce that no materials referenced in the Circular Letter are required to be independently filed with the Department.

Page 3: MWCIA Circular 15-1667 - NCCI Item P-1412- Terrorism Risk ...The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program

EXHIBIT 1

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 22 A B

Original Printing 2nd Reprint Effective September 1, 2008 January 1, 2015 Standard

Page 1 of 2

TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT

This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2007 2015. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism.

Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations.

Definitions

The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act .If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply.

“Act” means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2007 2015.

“Act of Terrorism” means any act that is certified by the Secretary of the Treasury, in concurrence with the Secretary of State, consultation with the Secretary of Homeland Security, and the Attorney General of the United States as meeting all of the following requirements:

a. The act is an act of terrorism.

b. The act is violent or dangerous to human life, property or infrastructure.

c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels.

d. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion.

“Insured Loss” means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels.

“Insurer Deductible” means, for the period beginning on January 1, 2008 2015, and ending on December 31, 2014 2020, an amount equal to 20% of our direct earned premiums, over the calendar year during the immediately preceding calendar year. the applicable Program Year.

“Program Year” refers to each calendar year between January 1, 2008 and December 31, 2014, as applicable.

Page 4: MWCIA Circular 15-1667 - NCCI Item P-1412- Terrorism Risk ...The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program

EXHIBIT 1

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 22 A B

Original Printing 2nd Reprint Effective September 1, 2008 January 1, 2015 Standard

Page 2 of 2

Limitation of Liability

The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program Year calendar year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury.

Policyholder Disclosure Notice

1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses exceed:

a. $100,000,000, with respect to such Insured Losses occurring in calendar year 2015, the United States Government would pay 85% of our Insured Losses that exceed our Insurer Deductible.

b. $120,000,000, with respect to such Insured Losses occurring in calendar year 2016, the United States Government would pay 84% of our Insured Losses that exceed our Insurer Deductible.

c. $140,000,000, with respect to such Insured Losses occurring in calendar year 2017, the United States Government would pay 83% of our Insured Losses that exceed our Insurer Deductible.

d. $160,000,000, with respect to such Insured Losses occurring in calendar year 2018, the United States Government would pay 82% of our Insured Losses that exceed our Insurer Deductible.

e. $180,000,000, with respect to such Insured Losses occurring in calendar year 2019, the United States Government would pay 81% of our Insured Losses that exceed our Insurer Deductible.

f. $200,000,000, with respect to such Insured Losses occurring in calendar year 2020, the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible.

$100,000,000 in a Program Year, the United States Government would pay 85% of our Insured Losses that exceed our Insurer Deductible. 2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any

portion of Insured Losses that exceed $100,000,000,000.

3. The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in Item 4 of the Information Page or in the Schedule below.

Schedule

State Rate Premium

Page 5: MWCIA Circular 15-1667 - NCCI Item P-1412- Terrorism Risk ...The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program

EXHIBIT 3

Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 01 14

(Ed. 1-14)

NOTIFICATION ENDORSEMENT OF PENDING LAW CHANGE TO TERRORISM RISK INSURANCE PROGRAM

REAUTHORIZATION ACT OF 2007

This endorsement is being sent to you with respect to your workers compensation and employers liability insurance policy. This endorsement does not replace the separate Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 A) that is attached to your current policy and which remains in effect as applicable. The Terrorism Risk Insurance Act of 2002 (TRIA) as previously amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2007 (TRIPRA), provides for a program under which the federal government will share in the payment of insured losses caused by certain acts of terrorism. In the absence of affirmative US Congressional action to extend, update, or otherwise reauthorize TRIPRA, in whole or in part, TRIPRA is scheduled to expire December 31, 2014. Since the timetable for any further Congressional action respecting TRIPRA is unknown at this time, and exposure to acts of terrorism remains, we are providing our policyholders with relevant information concerning their workers compensation policies in effect on or after January 1, 2014 in the event of TRIPRA’s expiration. Your policy provides coverage for workers compensation losses caused by acts of terrorism or war, including workers compensation benefit obligations dictated by state law, except in Pennsylvania where injuries or deaths resulting from certain war-related activities are excluded from workers compensation coverage. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy. The premium charge for the coverage your policy provides for terrorism or war losses is shown in Item 4 of the Information Page or the Schedule in the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 A) that is attached to your policy, and this amount may continue or change for new, renewal, and in-force policies in effect on or after December 31, 2014 in the event of TRIPRA’s expiration, subject to regulatory review in accordance with applicable state law. You need not do anything further at this time.

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

Endorsement Effective Policy No. Endorsement No.

Insured Premium:

Insurance Company Countersigned by __________________________________________

WC 00 01 14

(Ed. 1-14)

Page 6: MWCIA Circular 15-1667 - NCCI Item P-1412- Terrorism Risk ...The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program

EXHIBIT 3A P-1412

© Minnesota Workers’ Compensation Insurers Association, Inc. Rev 01/2015

Page 1 of 3

INDEX

MINNESOTA FORMS MANUAL

The following forms and endorsements in this Minnesota Forms Manual have been approved by the Minnesota

Commerce Department and are available for use in Minnesota.

Introduction

Workers’ Compensation and Employers Liability

Insurance Policy Rules

WC 00 00 00 C Workers Compensation and Employers Liability Insurance Policy

WC 00 01 01 A Defense Base Act Coverage Endorsement

WC 00 01 04 A Federal Employers’ Liability Act Coverage Endorsement

WC 00 01 06 A Longshore and Harbor Workers’ Compensation Act Coverage Endt

WC 00 01 08 A Nonappropriated Fund Instrumentalities Act Coverage Endorsement

WC 00 01 09 C Outer Continental Shelf Lands Act Coverage Endorsement

WC 00 01 11 Migrant and Season Agricultural Worker Protection Act Coverage

Endorsement

WC 00 01 14 Notification Endorsement of Pending Law Change to Terrorism

Risk Insurance Program Reauthorization Act of 2007

WC 00 02 01 B Maritime Coverage Endorsement

WC 00 02 03 Voluntary Compensation Maritime Coverage Endorsement

WC 00 02 04 Limited Maritime Coverage Endorsement

WC 00 03 01 A Alternate Employer Endorsement

WC 00 03 02 Designated Workplaces Exclusion Endorsement

WC 00 03 03 C Employers Liability Coverage Endorsement

WC 00 03 04 Insurance Company as Insured Endorsement

WC 00 03 05 Joint Venture as Insured Endorsement

WC 00 03 08 Partners, Officers and Others Exclusion Endorsement

WC 00 03 09 B Rural Utilities Service Endorsement

WC 00 03 10 Sole Proprietors, Partners, Officers and Others Coverage

Endorsement

WC 00 03 11 A Voluntary Compensation and Employers Liability Coverage Endt.

WC 00 03 13 Waiver of Our Right to Recover from Others Endorsement

WC 00 04 03 Experience Rating Modification Factor Endorsement

WC 00 04 05 Policy Period Endorsement

WC 00 04 06 A Premium Discount Endorsement

Page 7: MWCIA Circular 15-1667 - NCCI Item P-1412- Terrorism Risk ...The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program

EXHIBIT 3A P-1412

© Minnesota Workers’ Compensation Insurers Association, Inc. Rev 01/2015

Page 2 of 3

WC 00 04 09 Premium Determination Endorsement─ Former Self Insurers 1

WC 00 04 10 Premium Determination Endorsement─ Former Self Insurers 2

WC 00 04 12 Contingent Experience Rating Modification Factor Endorsement

WC 00 04 14 Notification of Change in Ownership Endorsement

WC 00 04 19 Premium Due Date Endorsement

WC 00 04 22 A B Terrorism Risk Insurance Program Reauthorization Act Disclosure

Endorsement

WC 00 05 03 C Retrospective Rating Plan Premium Endorsement─ One Year Plan

WC 00 05 04 C Retrospective Rating Plan Premium Endorsement─ Three Year

Plan

WC 00 05 05 C Retrospective Rating Plan Premium Endorsement─ Long-term

Wrap- Up Construction Project

WC 00 05 08 Retrospective Rating Plan Premium Endorsement Aviation Exclusion

WC 00 05 09 A Retrospective Rating Plan Premium Endorsement Changes

WC 00 05 10 B Retrospective Rating Plan Premium Endorsement Non- Ratable

Catastrophe Element or Surcharge

WC 00 05 11 Retrospective Rating Plan Premium Endorsement Short Form

WC 00 05 12 C Retrospective Rating Plan Premium Endorsement One Year Plan─

Multiple Lines

WC 00 05 13 C Retrospective Rating Plan Premium Endorsement Three Year Plan─

Multiple Lines

WC 00 05 14 C Retrospective Rating Plan Premium Endorsement Long- Term Wrap-

Up Construction Project ─ Multiple Lines

WC 00 05 15 A Retrospective Rating Plan Premium Endorsement Flexibility Options

WC 00 05 16 Retrospective Rating Plan Premium Endorsement─ Large Risk

Alternative Rating Option (LRARO)

WC 00 06 03 Benefits Deductible Endorsement

WC 89 06 09 C Policy Termination/ Cancellation/ Reinstatement Notice

WC 22 00 00 A Minnesota Amendatory Endorsement

WC 22 00 01 Information Page

WC 22 03 01 Minnesota Compliance with Applicable Trade Sanction Laws

WC 22 03 02 Minnesota Independent Contractors Coverage Endorsement

WC 22 03 03 Minnesota Third Degree of Kindred Family Member Exclusion Endt.

WC 22 03 04 Minnesota Employee Leasing Endorsement

WC 22 03 05 Minnesota Exclusion of Coverage for Leased Employees Endorsement

WC 22 03 06 Minnesota Alternate Employer Endorsement [Excluding Employers

Liability Coverage]

Page 8: MWCIA Circular 15-1667 - NCCI Item P-1412- Terrorism Risk ...The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program

EXHIBIT 3A P-1412

© Minnesota Workers’ Compensation Insurers Association, Inc. Rev 01/2015

Page 3 of 3

WC 22 04 01 Minnesota Contracting Premium Adjustment Program Endorsement

WC 22 04 02 Minnesota Anniversary Rating Date Endorsement

WC 22 06 00 Minnesota Policy Change Endorsement

WC 22 06 01 D Minnesota Cancellation and Nonrenewal Endorsement

WC 22 06 02 Minnesota Policy Information Page Endorsement Insured’s Name

WC 22 06 03 Minnesota Policy Information Page Endorsement Policy Number

WC 22 06 04 Minnesota Policy Information Page Endorsement Effective Date

WC 22 06 05 Minnesota Policy Information Page Endorsement Expiration Date

WC 22 06 06 Minnesota Policy Information Page Endorsement− Insured’s Mailing

Address

WC 22 06 07 Minnesota Policy Information Page Endorsement− Experience

Modification

WC 22 06 08 Minnesota Policy Information Page Endorsement Producer’s Name

WC 22 06 09 Minnesota Policy Information Page Endorsement− Change in Workplace

Endorsement

WC 22 06 10 Minnesota Policy Information Page Endorsement− Insured’s Legal Status

WC 22 06 11 Minnesota Policy Information Page Endorsement Add States

WC 22 06 12 Minnesota Policy Information Page Endorsement Employer Limits

WC 22 06 13 Minnesota Policy Information Page Endorsement Change in State

WC 22 06 14 Minnesota Policy information Page Endorsement− Endorsement Numbers

WC 22 06 15 A Minnesota Policy information Page Endorsement− Class, Rate, Other

Change

WC 22 06 16 A Minnesota Policy Information Page Endorsement− Interim Adjustment of

Premium

WC 22 06 17 Minnesota Policy Information Page Endorsement− Carrier Servicing Office

WC 22 06 18 Minnesota Policy Information Page Endorsement− Interstate/ Intrastate Risk

ID Number

WC 22 06 19 Minnesota Policy Information Page Endorsement Carrier Number

WC 22 06 20 Minnesota Entity Address Schedule

Page 9: MWCIA Circular 15-1667 - NCCI Item P-1412- Terrorism Risk ...The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program

NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC.(Applies in: AK, AL, AR, AZ, CO, CT, DC, FL, GA, HI, IA, ID, IL, KS,KY, LA, MD, ME, MO, MS, MT, NE, NH, NM, NV, OK, OR, RI, SC, SD,TN, TX, UT, VA, VT, WV)

P-1412PAGE 1

FILING MEMORANDUM

ITEM P-1412—TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF2015 ENDORSEMENTS

PURPOSE

This item revises and withdraws endorsements in NCCI’s Forms Manual of Workers Compensation andEmployers Liability Insurance (Forms Manual) as a result of the recent enactment of the Terrorism RiskInsurance Program Reauthorization Act of 2015 (TRIPRA of 2015).

BACKGROUND

The Terrorism Risk Insurance Act of 2002 (“TRIA” or the “Act”) was implemented as a result of the USCongress recognizing that terrorism is a catastrophe exposure that is real and significant for insurers ofworkers compensation and other lines of insurance. It initially provided a temporary program under which theFederal government would share in the payment of insured losses caused by certain acts of terrorism. TRIAwas scheduled to expire on December 31, 2005. It was renewed as the Terrorism Risk Insurance ExtensionAct (TRIEA) in 2005, and as the Terrorism Risk Insurance Program Reauthorization Act (TRIPRA) in 2007.NCCI filed several national items that proposed the necessary miscellaneous values, rules, and policy formsto implement the original TRIA and each of its renewals.

Recognizing that terrorism is a catastrophe exposure that continues to be significant for insurers of workerscompensation and other lines of insurance, the US Congress enacted TRIPRA of 2015. The key provisionsare as follows:• The Act was extended for six years and will expire December 31, 2020• An act of terrorism must be certified by the Secretary of the Treasury, in consultation with the Secretary of

Homeland Security, and the Attorney General of the United States

Beginning on January 1, 2016:• The current 85% Federal share of compensation under the Terrorism Insurance Program (Program)

decreases by one percentage point per calendar year until it is equal to 80%• The current Program trigger for aggregate industry insured losses to exceed $100 million increases by

$20 million per calendar year until it is equal to $200 million

The current $27.5 billion insurance marketplace aggregate retention amount increases by $2 billion percalendar year, beginning in 2015, until it is equal to $37.5 billion, and is subject to further revision thereafter

PROPOSAL

To implement the changes as a result of the enactment of TRIPRA of 2015, this item proposes the followingrevisions to NCCI’s Forms Manual:1. The Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22A) must be revised to:• Update the TRIPRA references to TRIPRA of 2015• Revise the definitions to conform to TRIPRA of 2015• Revise the Insurer Deductible provisions• Revise the Program trigger amounts and the Federal share of compensation provisions

The enclosed materials are copyrighted materials of the National Council on Compensation Insurance, Inc. ("NCCI"). The use of these materialsmay be governed by a separate contractual agreement between NCCI and its licensees such as an affiliation agreement between you and NCCI.Unless permitted by NCCI, you may not copy, create derivative works (by way of example, create or supplement your own works, databases,software, publications, manuals, or other materials), display, perform, or use the materials, in whole or in part, in any media. Such actions takenby you, or by your direction, may be in violation of federal copyright and other commercial laws. NCCI does not permit or acquiesce such use ofits materials. In the event such use is contemplated or desired, please contact NCCI's Legal Department for permission.

© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Page 10: MWCIA Circular 15-1667 - NCCI Item P-1412- Terrorism Risk ...The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program

NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC.(Applies in: AK, AL, AR, AZ, CO, CT, DC, FL, GA, HI, IA, ID, IL, KS,KY, LA, MD, ME, MO, MS, MT, NE, NH, NM, NV, OK, OR, RI, SC, SD,TN, TX, UT, VA, VT, WV)

P-1412PAGE 2

FILING MEMORANDUM

ITEM P-1412—TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF2015 ENDORSEMENTS

2. The Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement (WC 00 04 21 C)must be revised to update the references to the Terrorism Risk Insurance Program ReauthorizationAct Disclosure Endorsement.

3. The Notification Endorsement of Pending Law Change to Terrorism Risk Insurance ProgramReauthorization Act of 2007 (WC 00 01 14) must be withdrawn. The purpose of this endorsement was tonotify policyholders of the impending expiration of TRIPRA. However, with the enactment of TRIPRAof 2015, this endorsement is no longer needed.

4. The Florida Terrorism Risk Insurance Program Reauthorization Act Endorsement (WC 09 04 03 A)must be revised to:• Update the TRIPRA references to TRIPRA of 2015• Revise the definitions to conform to TRIPRA of 2015• Revise the Insurer Deductible provisions• Revise the Program trigger amounts and the Federal share of compensation provisions

5. The Texas Notification Endorsement of Pending Law Change to Terrorism Risk Insurance ProgramReauthorization Act of 2007 (WC 42 01 01) must be withdrawn. The purpose of this endorsement was tonotify policyholders of the impending expiration of TRIPRA. However, with the enactment of TRIPRAof 2015, this endorsement is no longer needed.

IMPACT

There will be no statewide premium impact as a result of the changes proposed in this item.

EXHIBIT COMMENTS AND IMPLEMENTATION SUMMARY

In all states except Hawaii, this item is to become effective for new, renewal, and outstanding policies effectiveon and after 12:01 a.m. on January 1, 2015.

In Hawaii, the effective date is determined upon regulatory approval of the individual carrier's election toadopt this change.

Exhibit Current Endorsement Name and Number Proposed Endorsement Name and Number1 • Terrorism Risk Insurance Program

Reauthorization Act DisclosureEndorsement (WC 00 04 22 A)

• Does not apply in Florida; refer to Exhibit4 for state-specific endorsement forFlorida.

• Terrorism Risk Insurance ProgramReauthorization Act Disclosure Endorsement(WC 00 04 22 B)

• Does not apply in Florida; refer to Exhibit 4 forstate-specific endorsement for Florida.

2 • Catastrophe (Other Than Certified Actsof Terrorism) Premium Endorsement(WC 00 04 21 C)

• Catastrophe (Other Than Certified Acts ofTerrorism) Premium Endorsement (WC 00 0421 D)

The enclosed materials are copyrighted materials of the National Council on Compensation Insurance, Inc. ("NCCI"). The use of these materialsmay be governed by a separate contractual agreement between NCCI and its licensees such as an affiliation agreement between you and NCCI.Unless permitted by NCCI, you may not copy, create derivative works (by way of example, create or supplement your own works, databases,software, publications, manuals, or other materials), display, perform, or use the materials, in whole or in part, in any media. Such actions takenby you, or by your direction, may be in violation of federal copyright and other commercial laws. NCCI does not permit or acquiesce such use ofits materials. In the event such use is contemplated or desired, please contact NCCI's Legal Department for permission.

© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Page 11: MWCIA Circular 15-1667 - NCCI Item P-1412- Terrorism Risk ...The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program

NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC.(Applies in: AK, AL, AR, AZ, CO, CT, DC, FL, GA, HI, IA, ID, IL, KS,KY, LA, MD, ME, MO, MS, MT, NE, NH, NM, NV, OK, OR, RI, SC, SD,TN, TX, UT, VA, VT, WV)

P-1412PAGE 3

FILING MEMORANDUM

ITEM P-1412—TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF2015 ENDORSEMENTS

Exhibit Current Endorsement Name and Number Proposed Endorsement Name and Number• Does not apply in AK, FL, MO, NM, TX,

and VA• Does not apply in AK, FL, MO, NM, TX, and VA

3 • Notification Endorsement of PendingLaw Change to Terrorism Risk InsuranceProgram Reauthorization Act of 2007(WC 00 01 14).

• Does not apply in Florida. Instead, Form09-Notice—Florida Notice of PendingLaw Change to Terrorism Risk InsuranceProgram Reauthorization Act of 2007applies in Florida. This nonfiled formwas provided for carriers to use at theirunderwriting discretion. Since it is anonfiled form, an exhibit to withdrawthe form is not included in this item.However, the form will be removed fromNCCI's Forms Manual effective January1, 2015 upon approval of this item.

• Does not apply in Texas; refer to Exhibit4 for state-specific endorsement forTexas.

N/A—Withdrawn

• Florida Terrorism Risk InsuranceProgram Reauthorization ActEndorsement (WC 09 04 03 A)

• Applies in Florida only

• Florida Terrorism Risk Insurance ProgramReauthorization Act Endorsement (WC 09 0403 B)

• Applies in Florida only

4

• Texas Notification Endorsement ofPending Law Change to Terrorism RiskInsurance Program Reauthorization Actof 2007 (WC 42 01 01)

• Applies in Texas only

N/A—Withdrawn

The enclosed materials are copyrighted materials of the National Council on Compensation Insurance, Inc. ("NCCI"). The use of these materialsmay be governed by a separate contractual agreement between NCCI and its licensees such as an affiliation agreement between you and NCCI.Unless permitted by NCCI, you may not copy, create derivative works (by way of example, create or supplement your own works, databases,software, publications, manuals, or other materials), display, perform, or use the materials, in whole or in part, in any media. Such actions takenby you, or by your direction, may be in violation of federal copyright and other commercial laws. NCCI does not permit or acquiesce such use ofits materials. In the event such use is contemplated or desired, please contact NCCI's Legal Department for permission.

© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Page 12: MWCIA Circular 15-1667 - NCCI Item P-1412- Terrorism Risk ...The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program

NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC. P-1412PAGE 4

ITEM P-1412—TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF2015 ENDORSEMENTS

EXHIBIT 1FORMS MANUAL OF WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCETERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE (WC

00 04 22 B)

TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT(WC 00 04 22 A– B)

This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended andextended by the Terrorism Risk Insurance Program Reauthorization Act of 2–0–0–7– 2015. It serves to notifyyou of certain limitations under the Act, and that your insurance carrier is charging premium for lossesthat may occur in the event of an Act of Terrorism.

Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, includingworkers compensation benefit obligations dictated by state law. Coverage for such losses is still subject toall terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or statelaws, rules, or regulations.

Definitions

The definitions provided in this endorsement are based on and have the same meaning as the definitionsin the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions inthe Act will apply.

“Act” means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and anyamendments thereto, including any amendments resulting from the Terrorism Risk Insurance ProgramReauthorization Act of 2–0–0–7– 2015.

“Act of Terrorism” means any act that is certified by the Secretary of the Treasury, in c–o–n–c–u–r–r–e–n–c–e– w–i–t–h– t–h–e–S–e–c–r–e–t–a–r–y– o–f–S–t–a–t–e–,– consultation with the Secretary of Homeland Security, and the Attorney General of theUnited States as meeting all of the following requirements:a. The act is an act of terrorism.b. The act is violent or dangerous to human life, property or infrastructure.c. The act resulted in damage within the United States, or outside of the United States in the case of thepremises of United States missions or certain air carriers or vessels.

d. The act has been committed by an individual or individuals as part of an effort to coerce the civilianpopulation of the United States or to influence the policy or affect the conduct of the United StatesGovernment by coercion.

“Insured Loss” means any loss resulting from an act of terrorism (and, except for Pennsylvania, includingan act of war, in the case of workers compensation) that is covered by primary or excess property andcasualty insurance issued by an insurer if the loss occurs in the United States or at the premises of UnitedStates missions or to certain air carriers or vessels.

“Insurer Deductible” means, for the period beginning on January 1, 2–0–0–8– 2015, and ending on December31, 2–0–1–4– 2020, an amount equal to 20% of our direct earned premiums, o–v–e–r– t–h–e– c–a–l–e–n–d–a–r– y–e–a–r– during theimmediately preceding calendar year. t–h–e– a–p–p–l–i–c–a–b–l–e– P–r–o–g–r–a–m– Y–e–a–r–.–

“–P–r–o–g–r–a–m– Y–e–a–r–”– r–e–f–e–r–s– t–o– e–a–c–h– c–a–l–e–n–d–a–r–y–e–a–r–b–e–t–w–e–e–n– J–a–n–u–a–r–y– 1–,–2–0–0–8– a–n–d– D–e–c–e–m–b–e–r–3–1–,–2–0–1–4–,–a–s– a–p–p–l–i–c–a–b–l–e–.–

© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

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00 04 22 B)

Limitation of Liability

The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in aP–r–o–g–r–a–m– Y–e–a–r– calendar year and if we have met our Insurer Deductible, we are not liable for the payment ofany portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate InsuredLosses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined bythe Secretary of the Treasury.

Policyholder Disclosure Notice1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industryInsured Losses exceed:a. $100,000,000, with respect to such Insured Losses occurring in calendar year 2015, the UnitedStates Government would pay 85% of our Insured Losses that exceed our Insurer Deductible.

b. $120,000,000, with respect to such Insured Losses occurring in calendar year 2016, the UnitedStates Government would pay 84% of our Insured Losses that exceed our Insurer Deductible.

c. $140,000,000, with respect to such Insured Losses occurring in calendar year 2017, the UnitedStates Government would pay 83% of our Insured Losses that exceed our Insurer Deductible.

d. $160,000,000, with respect to such Insured Losses occurring in calendar year 2018, the UnitedStates Government would pay 82% of our Insured Losses that exceed our Insurer Deductible.

e. $180,000,000, with respect to such Insured Losses occurring in calendar year 2019, the UnitedStates Government would pay 81% of our Insured Losses that exceed our Insurer Deductible.

f. $200,000,000, with respect to such Insured Losses occurring in calendar year 2020, the United StatesGovernment would pay 80% of our Insured Losses that exceed our Insurer Deductible.

$–1–0–0–,–0–0–0–,–0–0–0– i–n– a– P–r–o–g–r–a–m– Y–e–a–r–,– t–h–e– U–n–i–t–e–d– S–t–a–t–e–s– G–o–v–e–r–n–m–e–n–t–w–o–u–l–d– p–a–y– 8–5–%– o–f–o–u–r– I–n–s–u–r–e–d– L–o–s–s–e–s–t–h–a–t– e–x–c–e–e–d– o–u–r– I–n–s–u–r–e–r– D–e–d–u–c–t–i–b–l–e–.–

2. Notwithstanding item 1 above, the United States Government will not make any payment under the Actfor any portion of Insured Losses that exceed $100,000,000,000.

3. The premium charge for the coverage your policy provides for Insured Losses is included in the amountshown in Item 4 of the Information Page or in the Schedule below.

Schedule

State Rate Premium

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CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUMENDORSEMENT (WC 00 04 21 D)

CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT (WC 0004 21 C– D)

This endorsement is notification that your insurance carrier is charging premium to cover the losses thatmay occur in the event of a Catastrophe (other than Certified Acts of Terrorism) as that term is definedbelow. Your policy provides coverage for workers compensation losses caused by a Catastrophe (other thanCertified Acts of Terrorism). This premium charge does not provide funding for Certified Acts of Terrorismcontemplated under the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (–W–C–0–0– 0–4– 2–2– A–)– (WC 00 04 22 B), attached to this policy.

For purposes of this endorsement, the following definitions apply:• Catastrophe (other than Certified Acts of Terrorism): Any single event, resulting from an Earthquake,

Noncertified Act of Terrorism, or Catastrophic Industrial Accident, which results in aggregate workerscompensation losses in excess of $50 million.

• Earthquake: The shaking and vibration at the surface of the earth resulting from underground movementalong a fault plane or from volcanic activity.

• Noncertified Act of Terrorism: An event that is not certified as an Act of Terrorism by the Secretaryof Treasury pursuant to the Terrorism Risk Insurance Act of 2002 (as amended) but that meets all ofthe following criteria:a. It is an act that is violent or dangerous to human life, property, or infrastructure;b. The act results in damage within the United States, or outside of the United States in the case ofthe premises of United States missions or air carriers or vessels as those terms are defined in theTerrorism Risk Insurance Act of 2002 (as amended); and

c. It is an act that has been committed by an individual or individuals as part of an effort to coerce thecivilian population of the United States or to influence the policy or affect the conduct of the UnitedStates Government by coercion.

• Catastrophic Industrial Accident: A chemical release, large explosion, or small blast that is localized innature and affects workers in a small perimeter the size of a building.

The premium charge for the coverage your policy provides for workers compensation losses caused by aCatastrophe (other than Certified Acts of Terrorism) is shown in Item 4 of the Information Page or in theSchedule below.

Schedule

State Rate Premium

© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

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NOTIFICATION ENDORSEMENT OF PENDING LAW CHANGE TO TERRORISM RISKINSURANCE PROGRAM REAUTHORIZATION ACT OF 2007 (WC 00 01 14)

N–O–T–I–F–I–C–A–T–I–O–N– E–N–D–O–R–S–E–M–E–N–T– O–F– P–E–N–D–I–N–G– L–A–W– C–H–A–N–G–E– T–O– T–E–R–R–O–R–I–S–M– R–I–S–K– I–N–S–U–R–A–N–C–E–P–R–O–G–R–A–M– R–E–A–U–T–H–O–R–I–Z–A–T–I–O–N– A–C–T– O–F– 2–0–0–7– (–W–C– 0–0– 0–1– 1–4–)–

T–h–i–s– e–n–d–o–r–s–e–m–e–n–t– i–s– b–e–i–n–g– s–e–n–t– t–o– y–o–u– w–i–t–h– r–e–s–p–e–c–t– t–o– y–o–u–r– w–o–r–k–e–r–s– c–o–m–p–e–n–s–a–t–i–o–n– a–n–d– e–m–p–l–o–y–e–r–s– l–i–a–b–i–l–i–t–y–i–n–s–u–r–a–n–c–e– p–o–l–i–c–y–.– T–h–i–s– e–n–d–o–r–s–e–m–e–n–t– d–o–e–s– n–o–t– r–e–p–l–a–c–e– t–h–e– s–e–p–a–r–a–t–e– T–e–r–r–o–r–i–s–m– R–i–s–k– I–n–s–u–r–a–n–c–e– P–r–o–g–r–a–m–R–e–a–u–t–h–o–r–i–z–a–t–i–o–n– A–c–t–D–i–s–c–l–o–s–u–r–e– E–n–d–o–r–s–e–m–e–n–t– (–W–C– 0–0– 0–4– 2–2– A–)– t–h–a–t– i–s– a–t–t–a–c–h–e–d– t–o– y–o–u–r– c–u–r–r–e–n–t– p–o–l–i–c–y– a–n–d–w–h–i–c–h– r–e–m–a–i–n–s– i–n– e–f–f–e–c–t– a–s– a–p–p–l–i–c–a–b–l–e–.–

T–h–e– T–e–r–r–o–r–i–s–m– R–i–s–k– I–n–s–u–r–a–n–c–e– A–c–t–o–f–2–0–0–2– (–T–R–I–A–)– a–s– p–r–e–v–i–o–u–s–l–y– a–m–e–n–d–e–d– a–n–d– e–x–t–e–n–d–e–d– b–y– t–h–e– T–e–r–r–o–r–i–s–m– R–i–s–k–I–n–s–u–r–a–n–c–e– P–r–o–g–r–a–m– R–e–a–u–t–h–o–r–i–z–a–t–i–o–n– A–c–t–o–f–2–0–0–7– (–T–R–I–P–R–A–)–,–p–r–o–v–i–d–e–s– f–o–r– a– p–r–o–g–r–a–m– u–n–d–e–r–w–h–i–c–h– t–h–e– f–e–d–e–r–a–l–g–o–v–e–r–n–m–e–n–t–w–i–l–l–s–h–a–r–e– i–n– t–h–e– p–a–y–m–e–n–t–o–f– i–n–s–u–r–e–d– l–o–s–s–e–s– c–a–u–s–e–d– b–y– c–e–r–t–a–i–n– a–c–t–s– o–f– t–e–r–r–o–r–i–s–m– .– I–n– t–h–e– a–b–s–e–n–c–e– o–f–a–f–fi–r–m–a–t–i–v–e– U–S– C–o–n–g–r–e–s–s–i–o–n–a–l–a–c–t–i–o–n– t–o– e–x–t–e–n–d–,–u–p–d–a–t–e–,–o–r– o–t–h–e–r–w–i–s–e– r–e–a–u–t–h–o–r–i–z–e– T–R–I–P–R–A–,– i–n– w–h–o–l–e– o–r– i–n– p–a–r–t–,–T–R–I–P–R–A– i–s– s–c–h–e–d–u–l–e–d– t–o– e–x–p–i–r–e– D–e–c–e–m–b–e–r– 3–1–,– 2–0–1–4–.–

S–i–n–c–e– t–h–e– t–i–m–e–t–a–b–l–e– f–o–r– a–n–y– f–u–r–t–h–e–r– C–o–n–g–r–e–s–s–i–o–n–a–l–a–c–t–i–o–n– r–e–s–p–e–c–t–i–n–g– T–R–I–P–R–A– i–s– u–n–k–n–o–w–n– a–t– t–h–i–s– t–i–m–e–,– a–n–d–e–x–p–o–s–u–r–e– t–o– a–c–t–s– o–f– t–e–r–r–o–r–i–s–m– r–e–m–a–i–n–s–,–w–e– a–r–e– p–r–o–v–i–d–i–n–g– o–u–r–p–o–l–i–c–y–h–o–l–d–e–r–s– w–i–t–h– r–e–l–e–v–a–n–t– i–n–f–o–r–m–a–t–i–o–n– c–o–n–c–e–r–n–i–n–g–t–h–e–i–r–w–o–r–k–e–r–s– c–o–m–p–e–n–s–a–t–i–o–n– p–o–l–i–c–i–e–s– i–n– e–f–f–e–c–t–o–n– o–r– a–f–t–e–r– J–a–n–u–a–r–y– 1–,–2–0–1–4– i–n– t–h–e– e–v–e–n–t–o–f–T–R–I–P–R–A–’–s– e–x–p–i–r–a–t–i–o–n–.–

Y–o–u–r– p–o–l–i–c–y– p–r–o–v–i–d–e–s– c–o–v–e–r–a–g–e– f–o–r–w–o–r–k–e–r–s– c–o–m–p–e–n–s–a–t–i–o–n– l–o–s–s–e–s– c–a–u–s–e–d– b–y– a–c–t–s– o–f– t–e–r–r–o–r–i–s–m– o–r–w–a–r–,– i–n–c–l–u–d–i–n–g–w–o–r–k–e–r–s– c–o–m–p–e–n–s–a–t–i–o–n– b–e–n–e–fi–t– o–b–l–i–g–a–t–i–o–n–s– d–i–c–t–a–t–e–d– b–y– s–t–a–t–e– l–a–w–,– e–x–c–e–p–t– i–n– P–e–n–n–s–y–l–v–a–n–i–a– w–h–e–r–e– i–n–j–u–r–i–e–s– o–r–d–e–a–t–h–s– r–e–s–u–l–t–i–n–g– f–r–o–m– c–e–r–t–a–i–n– w–a–r–-–r–e–l–a–t–e–d– a–c–t–i–v–i–t–i–e–s– a–r–e– e–x–c–l–u–d–e–d– f–r–o–m– w–o–r–k–e–r–s– c–o–m–p–e–n–s–a–t–i–o–n– c–o–v–e–r–a–g–e–.–C–o–v–e–r–a–g–e– f–o–r– s–u–c–h– l–o–s–s–e–s– i–s– s–t–i–l–l–s–u–b–j–e–c–t– t–o– a–l–l– t–e–r–m–s–,–d–e–fi–n–i–t–i–o–n–s–,–e–x–c–l–u–s–i–o–n–s–,–a–n–d– c–o–n–d–i–t–i–o–n–s– i–n– y–o–u–r– p–o–l–i–c–y–.–

T–h–e– p–r–e–m– i–u–m– c–h–a–r–g–e– f–o–r– t–h–e– c–o–v–e–r–a–g–e– y–o–u–r–p–o–l–i–c–y– p–r–o–v–i–d–e–s– f–o–r– t–e–r–r–o–r–i–s–m– o–r–w–a–r– l–o–s–s–e–s– i–s– s–h–o–w–n– i–n– I–t–e–m–4– o–f– t–h–e– I–n–f–o–r–m–a–t–i–o–n– P–a–g–e– o–r– t–h–e– S–c–h–e–d–u–l–e– i–n– t–h–e– T–e–r–r–o–r–i–s–m– R–i–s–k– I–n–s–u–r–a–n–c–e– P–r–o–g–r–a–m– R–e–a–u–t–h–o–r–i–z–a–t–i–o–n–A–c–t– D–i–s–c–l–o–s–u–r–e– E–n–d–o–r–s–e–m–e–n–t– (–W–C– 0–0– 0–4– 2–2– A–)– t–h–a–t– i–s– a–t–t–a–c–h–e–d– t–o– y–o–u–r– p–o–l–i–c–y–,– a–n–d– t–h–i–s– a–m–o–u–n–t–m–a–y–c–o–n–t–i–n–u–e– o–r– c–h–a–n–g–e– f–o–r– n–e–w–,– r–e–n–e–w–a–l–,–a–n–d– i–n–-–f–o–r–c–e– p–o–l–i–c–i–e–s– i–n– e–f–f–e–c–t– o–n– o–r– a–f–t–e–r– D–e–c–e–m–b–e–r– 3–1–,–2–0–1–4– i–n–t–h–e– e–v–e–n–t–o–f–T–R–I–P–R–A–’–s– e–x–p–i–r–a–t–i–o–n–,–s–u–b–j–e–c–t– t–o– r–e–g–u–l–a–t–o–r–y– r–e–v–i–e–w– i–n– a–c–c–o–r–d–a–n–c–e– w–i–t–h– a–p–p–l–i–c–a–b–l–e– s–t–a–t–e– l–a–w–.

Y–o–u– n–e–e–d– n–o–t– d–o– a–n–y–t–h–i–n–g– f–u–r–t–h–e–r– a–t– t–h–i–s– t–i–m–e–.–

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FLORIDA TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACTENDORSEMENT (WC 09 04 03 B)

FLORIDA TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT ENDORSEMENT(WC 09 04 03 A– B)

This endorsement addresses requirements of the Terrorism Risk Insurance Act of 2002 as amended by theTerrorism Risk Insurance Program Reauthorization Act of 2–0–0–7– 2015.

Definitions

The definitions provided in this endorsement are based on and have the same meaning as the definitionsin the Act . If words or phrases not defined in this endorsement are defined in the Act, the definitions inthe Act will apply.1. “Act” means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, andany amendments, including any amendments resulting from the Terrorism Risk Insurance ProgramReauthorization Act of 2–0–0–7– 2015.

2. “Act of Terrorism” means any act that is certified by the Secretary of the Treasury, in c–o–n–c–u–r–r–e–n–c–e– w–i–t–h–t–h–e– S–e–c–r–e–t–a–r–y– o–f–S–t–a–t–e–,– consultation with the Secretary of Homeland Security, and the Attorney Generalof the United States as meeting all of the following requirements:a. The act is an act of terrorism.b. The act is violent or dangerous to human life, property or infrastructure.c. The act resulted in damage within the United States, or outside of the United States in the case of thepremises of United States missions or certain air carriers or vessels.

d. The act has been committed by an individual or individuals as part of an effort to coerce the civilianpopulation of the United States or to influence the policy or affect the conduct of the United StatesGovernment by coercion.

3. “Insured Loss” means any loss resulting from an act of terrorism (including an act of war, in the case ofworkers compensation) that is covered by primary or excess property and casualty insurance issuedby an insurer if the loss occurs in the United States or at the premises of United States missions or tocertain air carriers or vessels.

4. “Insurer Deductible” means, for the period beginning on January 1, 2–0–0–8– 2015, and ending on December31, 2–0–1–4– 2020, an amount equal to 20% of our direct earned premiums, o–v–e–r– t–h–e– c–a–l–e–n–d–a–r– y–e–a–r–during theimmediately preceding calendar year. t–h–e– a–p–p–l–i–c–a–b–l–e– P–r–o–g–r–a–m– Y–e–a–r– .–

5. “–P–r–o–g–r–a–m– Y–e–a–r–”– r–e–f–e–r–s– t–o– e–a–c–h– c–a–l–e–n–d–a–r– y–e–a–r– b–e–t–w–e–e–n– J–a–n–u–a–r–y– 1–,– 2–0–0–8– a–n–d– D–e–c–e–m–b–e–r– 3–1–,– 2–0–1–4–,– a–s–a–p–p–l–i–c–a–b–l–e–.–

Limitation of Liability

The Act may limit our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000in a P–r–o–g–r–a–m– Y–e–a–r– calendar year and if we have met our Insurer Deductible, we may not be liable for thepayment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregateInsured Losses up to $100,000,000,000, we may only have to pay a pro rata share of such Insured Lossesas determined by the Secretary of the Treasury.

Policyholder Disclosure Notice1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industryInsured Losses exceed:

© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

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FLORIDA TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACTENDORSEMENT (WC 09 04 03 B)

a. $100,000,000, with respect to such Insured Losses occurring in calendar year 2015, the UnitedStates Government would pay 85% of our Insured Losses that exceed our Insurer Deductible.

b. $120,000,000, with respect to such Insured Losses occurring in calendar year 2016, the UnitedStates Government would pay 84% of our Insured Losses that exceed our Insurer Deductible.

c. $140,000,000, with respect to such Insured Losses occurring in calendar year 2017, the UnitedStates Government would pay 83% of our Insured Losses that exceed our Insurer Deductible.

d. $160,000,000, with respect to such Insured Losses occurring in calendar year 2018, the UnitedStates Government would pay 82% of our Insured Losses that exceed our Insurer Deductible.

e. $180,000,000, with respect to such Insured Losses occurring in calendar year 2019, the UnitedStates Government would pay 81% of our Insured Losses that exceed our Insurer Deductible.

f. $200,000,000, with respect to such Insured Losses occurring in calendar year 2020, the United StatesGovernment would pay 80% of our Insured Losses that exceed our Insurer Deductible.

s– $–1–0–0–,–0–0–0–,–0–0–0– i–n– a– P–r–o–g–r–a–m– Y–e–a–r–,– t–h–e– U–n–i–t–e–d– S–t–a–t–e–s– G–o–v–e–r–n–m–e–n–t–w–o–u–l–d– p–a–y– 8–5–%– o–f–o–u–r– I–n–s–u–r–e–d– L–o–s–s–e–s–t–h–a–t– e–x–c–e–e–d– o–u–r– I–n–s–u–r–e–r– D–e–d–u–c–t–i–b–l–e–.–

2. Notwithstanding item 1 above, the United States Government may not have to make any payment underthe Act for any portion of Insured Losses that exceeds– $100,000,000,000.

3. The premium charged for the coverage for Insured Losses under this policy is included in the amountshown in Item 4 of the Information Page or the Schedule below.

Schedule

Rate per $100 of Remuneration

© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.

Page 18: MWCIA Circular 15-1667 - NCCI Item P-1412- Terrorism Risk ...The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program

NATIONAL COUNCIL ON COMPENSATION INSURANCE, INC. P-1412PAGE 10

ITEM P-1412—TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT OF2015 ENDORSEMENTS

EXHIBIT 4FORMS MANUAL OF WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCETEXAS NOTIFICATION ENDORSEMENT OF PENDING LAW CHANGE TO TERRORISM RISK

INSURANCE PROGRAM REAUTHORIZATION ACT OF 2007 (WC 42 01 01)

T–E–X–A–S– N–O–T–I–F–I–C–A–T–I–O–N– E–N–D–O–R–S–E–M–E–N–T– O–F– P–E–N–D–I–N–G– L–A–W– C–H–A–N–G–E– T–O– T–E–R–R–O–R–I–S–M– R–I–S–K–I–N–S–U–R–A–N–C–E– P–R–O–G–R–A–M– R–E–A–U–T–H–O–R–I–Z–A–T–I–O–N– A–C–T– O–F– 2–0–0–7– (–W–C– 4–2– 0–1– 0–1–)–

T–h–i–s– e–n–d–o–r–s–e–m–e–n–t– i–s– b–e–i–n–g– s–e–n–t– t–o– y–o–u– w–i–t–h– r–e–s–p–e–c–t– t–o– y–o–u–r– w–o–r–k–e–r–s– c–o–m–p–e–n–s–a–t–i–o–n– a–n–d– e–m–p–l–o–y–e–r–s– l–i–a–b–i–l–i–t–y–i–n–s–u–r–a–n–c–e– p–o–l–i–c–y–.–

T–h–e– T–e–r–r–o–r–i–s–m– R–i–s–k– I–n–s–u–r–a–n–c–e– A–c–t–o–f–2–0–0–2– (–T–R–I–A–)– a–s– p–r–e–v–i–o–u–s–l–y– a–m–e–n–d–e–d– a–n–d– e–x–t–e–n–d–e–d– b–y– t–h–e– T–e–r–r–o–r–i–s–m– R–i–s–k–I–n–s–u–r–a–n–c–e– P–r–o–g–r–a–m– R–e–a–u–t–h–o–r–i–z–a–t–i–o–n– A–c–t–o–f–2–0–0–7– (–T–R–I–P–R–A–)–,–p–r–o–v–i–d–e–s– f–o–r– a– p–r–o–g–r–a–m– u–n–d–e–r–w–h–i–c–h– t–h–e– f–e–d–e–r–a–l–g–o–v–e–r–n–m–e–n–t–w–i–l–l–s–h–a–r–e– i–n– t–h–e– p–a–y–m–e–n–t–o–f– i–n–s–u–r–e–d– l–o–s–s–e–s– c–a–u–s–e–d– b–y– c–e–r–t–a–i–n– a–c–t–s– o–f– t–e–r–r–o–r–i–s–m– .– I–n– t–h–e– a–b–s–e–n–c–e– o–f–a–f–fi–r–m–a–t–i–v–e– U–S– C–o–n–g–r–e–s–s–i–o–n–a–l–a–c–t–i–o–n– t–o– e–x–t–e–n–d–,–u–p–d–a–t–e–,–o–r– o–t–h–e–r–w–i–s–e– r–e–a–u–t–h–o–r–i–z–e– T–R–I–P–R–A–,– i–n– w–h–o–l–e– o–r– i–n– p–a–r–t–,–T–R–I–P–R–A– i–s– s–c–h–e–d–u–l–e–d– t–o– e–x–p–i–r–e– D–e–c–e–m–b–e–r– 3–1–,– 2–0–1–4–.–

S–i–n–c–e– t–h–e– t–i–m–e–t–a–b–l–e– f–o–r– a–n–y– f–u–r–t–h–e–r– C–o–n–g–r–e–s–s–i–o–n–a–l–a–c–t–i–o–n– r–e–s–p–e–c–t–i–n–g– T–R–I–P–R–A– i–s– u–n–k–n–o–w–n– a–t– t–h–i–s– t–i–m–e–,– a–n–d–e–x–p–o–s–u–r–e– t–o– a–c–t–s– o–f– t–e–r–r–o–r–i–s–m– r–e–m–a–i–n–s–,–w–e– a–r–e– p–r–o–v–i–d–i–n–g– o–u–r–p–o–l–i–c–y–h–o–l–d–e–r–s– w–i–t–h– r–e–l–e–v–a–n–t– i–n–f–o–r–m–a–t–i–o–n– c–o–n–c–e–r–n–i–n–g–t–h–e–i–r–w–o–r–k–e–r–s– c–o–m–p–e–n–s–a–t–i–o–n– p–o–l–i–c–i–e–s– i–n– e–f–f–e–c–t–o–n– o–r– a–f–t–e–r– J–a–n–u–a–r–y– 1–,–2–0–1–4– i–n– t–h–e– e–v–e–n–t–o–f–T–R–I–P–R–A–’–s– e–x–p–i–r–a–t–i–o–n–.–

Y–o–u–r– p–o–l–i–c–y– p–r–o–v–i–d–e–s– c–o–v–e–r–a–g–e– f–o–r–w–o–r–k–e–r–s– c–o–m–p–e–n–s–a–t–i–o–n– l–o–s–s–e–s– c–a–u–s–e–d– b–y– a–c–t–s– o–f– t–e–r–r–o–r–i–s–m– o–r–w–a–r–,– i–n–c–l–u–d–i–n–g–w–o–r–k–e–r–s– c–o–m–p–e–n–s–a–t–i–o–n– b–e–n–e–fi–t–o–b–l–i–g–a–t–i–o–n–s– d–i–c–t–a–t–e–d– b–y– s–t–a–t–e– l–a–w–.– C–o–v–e–r–a–g–e– f–o–r– s–u–c–h– l–o–s–s–e–s– i–s– s–t–i–l–l–s–u–b–j–e–c–t– t–o– a–l–l–t–e–r–m–s–,– d–e–fi–n–i–t–i–o–n–s–,– e–x–c–l–u–s–i–o–n–s–,– a–n–d– c–o–n–d–i–t–i–o–n–s– i–n– y–o–u–r– p–o–l–i–c–y–.–

T–h–e– p–r–e–m– i–u–m– c–h–a–r–g–e– f–o–r– t–h–e– c–o–v–e–r–a–g–e– y–o–u–r– p–o–l–i–c–y– p–r–o–v–i–d–e–s– f–o–r– t–e–r–r–o–r–i–s–m– o–r– w–a–r– l–o–s–s–e–s– m–a–y– c–o–n–t–i–n–u–e–o–r– c–h–a–n–g–e– f–o–r– n–e–w–,– r–e–n–e–w–a–l–,–a–n–d– i–n–-–f–o–r–c–e– p–o–l–i–c–i–e–s– i–n– e–f–f–e–c–t– o–n– o–r– a–f–t–e–r– D–e–c–e–m–b–e–r– 3–1–,–2–0–1–4– i–n– t–h–e– e–v–e–n–t–o–f– T–R–I–P–R–A–’–s– e–x–p–i–r–a–t–i–o–n–,–s–u–b–j–e–c–t– t–o– r–e–g–u–l–a–t–o–r–y– r–e–v–i–e–w– i–n– a–c–c–o–r–d–a–n–c–e– w–i–t–h– a–p–p–l–i–c–a–b–l–e– s–t–a–t–e– l–a–w–.–

Y–o–u– n–e–e–d– n–o–t– d–o– a–n–y–t–h–i–n–g– f–u–r–t–h–e–r– a–t– t–h–i–s– t–i–m–e–.–

© Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved.