
The Department of Insurance has several forms available for download for employers. Some forms are required to be filed and posted and some designate relationships so as to legally define them for the purposes of Workers Compensation. These are some of the commonly used forms. A full listing of employer-related forms can be found at the TDI website.
Form DWC005: Employer Notice of No Coverage or Termination of Coverage - This form is required of all Texas employers. The form tells the State of Texas one of two things: either you are electing to not carry Workers Compensation coverage for your employees or that you have terminated your coverage if you were carrying a workers compensation policy. A copy of this form can be downloaded here.
Notice 5: Notice to Employees Concerning Workers' Compensation in Texas - If you elect to not carry Workers' Compensation, this notice must be posted in an area where all employees are likely to view it. It advises them that Workers' Compensation is not provided by their employer as well as information for reporting unsafe working envitonments. The notice can be downloaded from here.
Form DWC081: Agreement Between General Contractor and Subcontractor to Provide Workers' Compensation Insurance - States that the General Contractor will provide Workers' Compensation and whether the cost of coverage will or will not be withheld from the contracted price. The form can be downloaded here.
Form DWC082: Agreement Between Motor Carrier and Owner Operator to Provide Workers’ Compensation Insurance Coverage / Agreement to Require Owner Operator to Act as Employer - This form is a statement between a motor carrier and an owner operator in which either the motor carrier agrees to extend workers compensation to the owner operator or the owner operator is acting as an employer thereby relieving the motor carrier from extending said coverage. The form can be downloaded here.
Form DWC083: Joint Agreement to Affirm Independent Relationship for Certain Building and Construction Workers / Agreement to Establish Employer-Employee Relationship for Certain Building and Construction Workers - This form has one of two purposes. It can be used to affirm that the relationship beween a hiring contractor and the hired contractor is independent. In this case, the hired contractor can bring no injury related claims to the hiring contractor for himself or his employees and the hiring contractor has no responsibility to be required to pay workers compensation premium for the hired contractor. It can also be used by a hiring contractor to affirm that he/she is extending workers compensation coverage to an independent contractor and his/her employees. This form can be downloaded here.
Form DWC085, Agreement Between General Contractor and Subcontractor to Establish Independent Relationship - If you carry a Workers Compensation policy for your business and you outsource work to a subcontractor, it is highly recommended you have your subcontractor sign this form. This clearly states their role in your organization and prevents you from potentially paying a work related claim for a subcontractor. This form can be downloaded here.