Client Company Policy for any Nonleased Employees


Industry InformationProfessional Employer Organizations (PEO) 

The following reporting guidelines provide key data elements needed to identify PEO/Employee Leasing policies for the purpose of Proof of Coverage and Experience Rating. They do not include all data elements required in accordance with the WCPOLS and WCSTAT sections of the WCIO Workers Compensation Data Specifications Manual. Please refer to the WCIO Manual for those additional data elements and fields that are required or optional.

Also below are Policy Reporting instructions for Deleting Names & Addresses.

Policy Key Data Elements:

​Header Record (Record Type Code 01)
Policy Type ID Code — Plan Indicator:
1 —Voluntary Policy or
2 — Normal Assigned Risk Policy
Employee Leasing Policy Type Code:
6—Client Company Policy for Non-Leased Workers of Client Company
Name Record (Record Type Code 02) —Primary Name
Insured Name:
Client Company Name (Primary Name)
Professional Employer Organization or Client Company Code:
C—Not a Professional Employer Organization Policy
Federal Employer Identification Number:
Client Company Fein (Primary FEIN)
Name Link Identifier:
Continuation Sequence Number:
Name Link Counter Identifier:
00 (For Up to 999 Names)
Address Record (Record Type Code 03) —Primary Address
Insured Address:
Client Company Mailing Address
Name Link Identifier:
Type of Address Code:
1 —Mailing Address of Insured
Address Record (Record Type Code 03) —Additional Address #1
Insured Address:
Client Company Location of Operation
Name Link Identifier:
Type of Address Code:
2 —Address of a Location of Operations
Endorsement Identification Record (Record Type Code 07)
Endorsement Number:
Report the State-Specific Endorsement Number

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Unit Key Data Elements:

Header Record (Record Type Code 01)
Employee Leasing Code:
E —Employee Leasing Policy
Federal Employer Identification Number:
Client Company FEIN
Risk ID Number:
Client Company Risk ID Number
Name Record (Record Type Code 02)
Insured Name:
Client Company (Insured Name)
Address Record (Record Type Code 03)
Insured Address:
Client Company Address (Insured Address)
Exposure Record (Record Type Code 04) and Loss Record (Record Type Code 05)
Report in accordance to URE Workers Compensation Statistical Plan
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Deleting Names and Addresses

Applicable Record Types and Transaction Codes:

The policy reporting instructions apply to data submitted electronically in the WCPOLS format, Record Types 02 (Name Record) and 03 (Address Record), and the following Transaction Codes:
  • Transaction 08—Policy Replacement Due to Rating Change
  • Transaction 10—Policy Replacement Due to Non-Rating Change
  • Transaction 14—Policy Replacement Due to Miscellaneous Change/Non-Key Field Change
  • Transaction 15—Policy Replacement Due to Add/Delete State Change
NOTE: This process does not apply to Transaction Code 03 with Record Types 88 and 89

Reporting Instructions:

Report the date the name and address is to be deleted in both the Policy Changes Effective Date and the Policy Changes Expiration Date fields. When these fields are reported with the same date, this will identify the record is deleted. In addition, if submitting a full policy replacement change transaction subsequent to deleting a name or address, do not resubmit the deleted name and address.

When reporting a deleted name and address hardcopy, submit an endorsement requesting to have the name and any applicable addresses deleted along with the date the name and address is being deleted. For additional information regarding deleting names and addresses, please reference circular number POLS-2005-02.

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