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SECTION I PARTS ONE and TWO PART THREE 1. WE WILLALSO PAY 2. How This Insurance Applies D. We Will Also Pay of Part One (WORKERS' Paragraph 4. of A. How This Insurance Applies of COMPENSATION INSURANCE); and Part 3 (Other States Insurance) is replaced by the E. We Will Also Pay of Part Two following: (EMPLOYERS' LIABILITY INSURANCE) is 4. If you have work on the effective date of this replaced by the following: policy in any state not listed in Item 3.A, of the We Will Also Pay Information Page, coverage will not be afforded We will also pay these costs, in addition to for that state unless we are notified within sixty days. other amounts payable under this insurance, as part of any claim, proceeding, or suit we PART SIX defend 3. 1, reasonable expenses incurred at our Transfer Of Your Rights and Duties request, INCLUDING loss of earnings; C. Transfer Of Your Rights and Duties of Part 6 2. premiums for bonds to release (Conditions) Is replaced by the following: attachments and for appeal bonds in Your rights or duties under this policy may not be bond amounts up to the limit of our transferred without our written consent. liability under this insurance; If you die and we receive notice within sixty days 3. litigation costs taxed against you; after your death, we will cover your legal 4.. interest on a judgment as required by law representative as insured, until we offer the amount due under this 4. Liberalization law; and If we adopt a change in this form that would broaden 5. expenses we incur, the coverage of this form without extra charge, the broader coverage will apply to this policy. it will apply when the change becomes effective in your state. SECTION If VOLUNTARY COMPENSATION ANDEMPLOYERS' 3. The bodily injury must occur in the United LIABILITY COVERAGE States of America, Its territories or 5. Voluntary Compensation Insurance possessions, or Canada, and may occur A. How This Insurance Applies elsewhere if the employee is a United States This insurance applies to bodily injury by or Canadian citizen, or otherwise legal resident, and legally employed, in the United accident or bodily Injury by disease. Bodily injury States or Canada and temporarily away from includes resulting death. those places. 1. The bodily injury must be sustained by 4. Bodily injury by accident must occur during any officer or employee not subject to the the policy period. workers' compensation law of any state shown in Item 3.A. of the Information 5. Bodily injury by disease must be paused or Page, aggravated by the conditions of the 2. The bodily injury must arise out of and in the course of employment or incidental to work in a state shown in Item 3.A. of the Information Page, Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) Page 2 of 6