Blank Texas Notice PDF Form

Who must file the DWC Form-005?

The DWC Form-005 must be filed by employers who do not have workers' compensation insurance or who have terminated their workers' compensation insurance coverage. However, if an employer's only employees are exempt from coverage under the Texas Workers' Compensation Act, such as certain domestic workers or specific farm and ranch workers, filing is not required. It is important to note that failing to file the form when necessary may result in administrative penalties for the employer.

How do I file the DWC Form-005?

Employers have several options for submitting the DWC Form-005 to the Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC). The form can be filed electronically through the TDI website, faxed to (512) 804-4146, or mailed to the address provided at the top of the form. Each method ensures that the necessary information reaches the appropriate authorities in a timely manner.

When do I file the DWC Form-005?

A separate DWC Form-005 must be filed whenever specific conditions arise. These conditions include filing annually between February 1st and April 30th of each year, within 30 days of hiring the first employee, within 10 days of receiving a request from the DWC to file the form, and within 10 days after notifying the insurance carrier of coverage termination unless a new policy is purchased or the employer becomes a certified self-insurer.

How do I determine my filing start date?

The filing start date is generally May 1, unless certain conditions apply. If the employer has never filed a DWC Form-005, the start date is the first day without coverage. If coverage has been terminated, the start date is the first date without coverage. If the employer hires their first employee, the start date is the day that employee begins work.

Are any fields on the DWC Form-005 optional?

No fields on the DWC Form-005 are optional. Each applicable field must be completed whenever the form is filed. This includes required effective dates, policy and insurer information when reporting cancellation or termination of coverage, and necessary details regarding the primary employer. All sections must be filled out accurately to ensure compliance with reporting requirements.

1. Ignoring Effective Dates: The effective dates must be within a one-year period. Failing to adhere to this can lead to complications.

2. Not Selecting a Coverage Status: Employers must clearly indicate whether they do not have coverage or have terminated coverage. Leaving this section blank is a common error.

3. Omitting Required Information: Essential details such as the policy number, insurance company, and notification dates must be provided when terminating coverage. Missing any of these can invalidate the form.

4. Incorrectly Reporting Injuries: If there have been any reportable injuries or diseases, employers must answer the relevant question accurately. Misreporting can lead to penalties.

5. Neglecting to Provide Employer Information: All fields regarding the employer's business name, Federal Employer ID Number, and address are mandatory. Incomplete information can cause delays.

6. Forgetting to Sign the Form: While signatures are not required for online submissions, failing to sign when submitting by fax or mail can result in rejection of the form.

7. Missing the Filing Deadlines: Employers must be aware of specific deadlines for filing the form. Late submissions can incur administrative penalties.

8. Not Keeping Copies: Failing to retain a copy of the submitted form can create issues if there are questions or disputes later.

9. Overlooking Employee Notifications: Employers must notify employees about lack of coverage. Not doing so can lead to compliance issues.

When dealing with workers' compensation issues in Texas, several forms and documents are often used in conjunction with the Texas Notice form (DWC Form-005). Understanding these documents is crucial for employers to ensure compliance with state regulations and to protect their employees. Below is a list of commonly associated forms and documents.

• DWC Form-007: Employer's Report of Non-covered Employee's Occupational Injury or Diseases - This form is required if you have five or more employees and do not carry workers' compensation insurance. It must be filed within seven days after any work-related death or injury that causes an employee to miss more than one day of work.
• Notice to Employees Concerning Workers' Compensation in Texas - Employers must post this notice in the workplace to inform employees about the lack of workers' compensation coverage. It must be provided in multiple languages if necessary and should be displayed prominently.
• DWC Form-003: Employee's Claim for Compensation for a Work-Related Injury - This form is used by employees to file a claim for benefits after sustaining a work-related injury. It outlines the details of the injury and the compensation being sought.
• DWC Form-041: Request for a Benefit Review Conference - If there is a dispute regarding a workers' compensation claim, this form allows either party to request a conference to resolve the issue. It is a step before potentially escalating to a hearing.
• DWC Form-006: Notice of Change of Address - Employers must use this form to notify the Texas Department of Insurance of any changes to their business address. Keeping this information current is essential for communication purposes.
• DWC Form-005: Employer's Notice of No Coverage or Termination of Coverage - This is the primary form being discussed. It is filed to notify the Texas Department of Insurance when an employer does not have or has terminated their workers' compensation insurance coverage.
• DWC Form-008: Request for Medical Examination - This form is used to request a medical examination for an employee who is claiming benefits for a work-related injury. It helps in determining the extent of the injury and the appropriate compensation.
• DWC Form-009: Report of Injury - This form is used to report an injury that occurs at the workplace. It is essential for documenting incidents and initiating the claims process.

Employers must be diligent in understanding and completing these forms accurately and timely. Failure to do so can lead to penalties and complications in managing workers' compensation claims. It is advisable to consult with a professional if there are any uncertainties regarding these documents.

• Employer's Report of Occupational Injury or Illness (DWC Form-007): Similar to the Texas Notice form, this document is filed by employers to report work-related injuries or diseases. It is required when there are reportable incidents, ensuring that the employer maintains compliance with state regulations.
• Notice to Employees Concerning Workers' Compensation in Texas: This notice is required when an employer does not provide workers' compensation coverage. It informs employees of their rights and the absence of coverage, much like the Texas Notice form communicates coverage status.
• Employer's Quarterly Report (Form C-3): This form is used to report wages and employment information to the Texas Workforce Commission. It provides essential data about the employer's workforce, similar to how the Texas Notice form requires employer identification and business details.
• Texas Workers' Compensation Policy Cancellation Notice: This document notifies the Texas Department of Insurance of a policy cancellation. Like the Texas Notice form, it serves to inform relevant parties about changes in coverage status.
• Self-Insurance Application: Employers seeking to self-insure must submit this application. It parallels the Texas Notice form in that both require detailed information about the employer's operations and coverage status.
• Annual Report of Non-Subscriber Employers: Non-subscribers must submit this report to provide information about their employee injuries. This requirement aligns with the Texas Notice form's purpose of ensuring that employers report their coverage status.
• Workers' Compensation Coverage Verification Request: Employers can use this request to verify their coverage status with the Texas Department of Insurance. It is similar to the Texas Notice form, which aims to clarify an employer's coverage situation.
• Employer's Insurance Coverage Information Form: This form provides details about an employer's insurance coverage. Like the Texas Notice form, it is crucial for maintaining transparency and compliance with state regulations.

When filling out the Texas Notice form, it is essential to follow certain guidelines to ensure accuracy and compliance. Below is a list of things you should and shouldn't do during this process.

• Do ensure all required fields are completed accurately.
• Do use the correct effective dates for coverage.
• Do provide the policy number and insurance company details if coverage has been terminated.
• Do notify employees about the lack of coverage promptly.
• Do file the form within the specified deadlines.

• Don't leave any mandatory fields blank.
• Don't submit the form late, as this may result in penalties.
• Don't forget to keep copies of the submitted form for your records.
• Don't assume that electronic submissions do not require a signature; check the requirements.
• Don't ignore the need for a NAICS code if applicable to your business.

• Misconception 1: The Texas Notice form is only for employers who have workers' compensation insurance.

This is incorrect. The form must be filed by employers who do not have workers' compensation insurance or have terminated their coverage. It is essential for compliance with Texas law.

• Misconception 2: Filing the Texas Notice form is optional for all employers.

Filing is mandatory for employers who lack coverage or have terminated their policy. Failing to file can lead to administrative penalties.

• Misconception 3: The Texas Notice form can be filed at any time without a deadline.

This is misleading. Employers must file the form annually, within 30 days of hiring their first employee, or within 10 days of terminating coverage. Specific deadlines must be followed.

• Misconception 4: Only the primary employer's information is required on the form.

This is not true. The form requires details about all business locations and any subsidiaries associated with the primary employer. Complete information is crucial.

• Misconception 5: The signature on the Texas Notice form is always required.

This is not accurate. If the form is submitted online, a signature is not necessary. However, it is required for paper submissions.

• Misconception 6: Employers do not need to notify employees if they do not have coverage.

This is incorrect. Employers must inform their employees about the lack of workers' compensation insurance. This notification must be provided at the time of hire and under various circumstances outlined by law.

• Understand the Purpose: The Texas Notice form is essential for employers to report the lack of workers' compensation insurance or the termination of existing coverage. This ensures compliance with the Texas Workers' Compensation Act.

• Timely Filing: Employers must submit the form annually between February 1st and April 30th, or within specific time frames related to hiring employees or terminating coverage. Adhering to these deadlines is crucial to avoid penalties.

• Complete All Required Fields: Every section of the form must be filled out accurately. This includes effective dates, policy information, and employer details. Missing information can lead to complications or delays.

• Reportable Injuries: If there have been any work-related injuries or diseases since the last notice, employers may need to file an additional form, the DWC Form-007. This requirement highlights the importance of tracking workplace incidents.

• Notification to Employees: Employers are required to inform their employees about the lack of coverage. This notification must be provided in multiple languages if necessary, ensuring all employees understand their coverage status.

• NAICS Code: Employers must include their North American Industry Classification System (NAICS) code on the form. This code helps categorize the business and can often be found on other official reports.

• Submission Methods: The form can be submitted electronically, via fax, or by mail. Employers should choose the method that best suits their needs while ensuring timely delivery.