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Free Dwc 83 Form

The DWC 83 form is a declaration used in Texas to establish the relationship between a Hiring Contractor and an Independent Contractor. This form outlines the independent status of the contractor, confirming that they are not considered an employee under Texas Workers' Compensation laws. Completing this form is essential for both parties to ensure clarity regarding workers' compensation coverage and responsibilities.

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The DWC 83 form is an essential document for those involved in the construction industry in Texas, specifically for establishing the relationship between hiring contractors and independent contractors. This form serves two primary purposes: it can either affirm an independent contractor's status or create an employer-employee relationship for the purposes of workers' compensation coverage. When both parties sign the form, they declare that the independent contractor meets the qualifications outlined in the Texas Workers' Compensation Act, ensuring they are not considered an employee of the hiring contractor. This declaration is crucial because it clarifies that the independent contractor and their employees will not receive workers' compensation coverage from the hiring contractor, relieving the contractor of any associated premium obligations. Conversely, if both parties choose to establish an employer-employee relationship, the hiring contractor agrees to withhold costs for workers' compensation insurance and assumes the role of employer solely for insurance purposes. The DWC 83 form must be filed with the Texas Department of Insurance and the contractor's insurance carrier within a specific timeframe, ensuring compliance with state regulations. Understanding the implications of this form is vital for both hiring contractors and independent contractors, as it directly impacts their rights and responsibilities under Texas law.

How to Use Dwc 83

Filling out the DWC 83 form is a critical step for establishing the independent contractor relationship under Texas law. Once the form is completed and submitted, it will be reviewed by the Texas Department of Insurance, Division of Workers’ Compensation. This process ensures that both parties are clear about their roles and responsibilities regarding workers' compensation coverage.

  1. Obtain the DWC 83 form from the Texas Department of Insurance, Division of Workers’ Compensation website or office.
  2. Fill in the names and addresses of both the Hiring Contractor and the Independent Contractor at the top of the form.
  3. Check the appropriate box to indicate whether you are affirming an independent relationship or establishing an employer-employee relationship.
  4. Complete the section regarding the term of the agreement by entering the start and end dates.
  5. Specify the location of each affected job site or indicate if this is a blanket agreement.
  6. Provide the estimated number of employees affected by this agreement.
  7. Have the Hiring Contractor sign and date the form, including their printed name and address.
  8. Have the Independent Contractor sign and date the form, including their printed name and address.
  9. Make four copies of the completed form for your records and for submission.
  10. Submit the original form to the Texas Department of Insurance, Division of Workers’ Compensation, either by personal delivery or registered/certified mail within 10 days of execution.

Documents used along the form

The DWC 83 form is an important document used in the context of workers' compensation in Texas. It serves as a declaration of the independent contractor status between the hiring contractor and the independent contractor. Several other forms and documents are often utilized in conjunction with the DWC 83 to ensure compliance with legal requirements and to clarify the relationship between parties involved. Below is a list of these documents, along with a brief description of each.

  • DWC Form-1: This form is used to report an injury to the Texas Department of Insurance, Division of Workers' Compensation. It provides essential details about the injured employee and the circumstances surrounding the incident.
  • Motor Vehicle Bill of Sale: A vital document for buyers and sellers, securing the legal transfer of vehicle ownership, similar to the Bill of Sale for a Vehicle which can facilitate this process.
  • DWC Form-4: This document is a notification of an employee's injury and is submitted by the employer. It helps ensure that the employee receives the necessary benefits and medical care.
  • DWC Form-5: This form is used to initiate a claim for workers' compensation benefits. It includes information about the injured worker and the nature of the injury, allowing for a formal claim process to begin.
  • DWC Form-7: This is a notice of refusal to pay benefits. Employers must file this form if they deny a claim for benefits, detailing the reasons for the denial.
  • DWC Form-8: This form serves as a notice of non-compliance. It is used when an employer does not have the required workers' compensation insurance coverage.
  • DWC Form-9: This is a report of injury that is used by the employer to provide a summary of the injury and the actions taken following the incident. It is essential for record-keeping and compliance.
  • DWC Form-14: This document is a notice of change in the status of a claim. It informs the Texas Department of Insurance and other parties about any changes in the claim, such as changes in the injured worker’s medical condition or return to work.
  • DWC Form-15: This form is used to request a hearing regarding a dispute over workers' compensation benefits. It outlines the issues in dispute and initiates the hearing process.
  • DWC Form-16: This document serves as a notice of a change in the insurance carrier. It is important for ensuring that all parties are aware of the current insurance provider and coverage details.

Each of these forms plays a critical role in the workers' compensation process in Texas. It is essential for both hiring contractors and independent contractors to understand their responsibilities and ensure that all necessary documentation is completed accurately and submitted on time. By doing so, they can help protect their rights and ensure compliance with Texas labor laws.

Crucial Queries on Dwc 83

What is the purpose of the DWC 83 form?

The DWC 83 form is used in Texas to establish the relationship between a Hiring Contractor and an Independent Contractor in the context of workers' compensation. This form helps clarify whether the Independent Contractor is truly independent and not an employee of the Hiring Contractor. By completing this form, both parties agree on the terms of their working relationship and confirm that the Independent Contractor will not receive workers' compensation coverage from the Hiring Contractor.

Who qualifies as an Independent Contractor under the DWC 83 form?

An Independent Contractor is defined under the Texas Workers' Compensation Act. To qualify, a person must be paid by the job rather than by the hour. They should also have the freedom to hire helpers and set their pay. Importantly, they can work for other contractors while under contract with the Hiring Contractor. If you are unsure whether someone meets these criteria, consulting an attorney is advisable.

What happens if a new hiring agreement is made after filing the DWC 83 form?

If a new hiring agreement is created that does not apply under the DWC 83 form, both the Hiring Contractor and the Independent Contractor must notify the Texas Department of Insurance and the Hiring Contractor's workers' compensation insurance carrier in writing within 10 days. This ensures that all parties are aware of any changes in the working relationship and their implications for workers' compensation coverage.

How should the DWC 83 form be filed?

The DWC 83 form must be filed by the Hiring Contractor with both the Texas Department of Insurance and the workers' compensation insurance carrier. This should be done within 10 days of signing the agreement. The form can be submitted by personal delivery or via registered or certified mail. It is essential for both parties to keep a copy of the signed agreement for their records.

Dos and Don'ts

When filling out the DWC 83 form, it is important to follow certain guidelines to ensure accuracy and compliance. Below are some recommended practices and common pitfalls to avoid.

  • Do read the entire form carefully before filling it out to understand all requirements.
  • Do ensure that all parties involved meet the qualifications for independent contractors as defined by Texas law.
  • Do provide accurate and complete information, including Federal Tax I.D. numbers for both the Hiring Contractor and the Independent Contractor.
  • Do sign and date the form in the designated areas to validate the agreement.
  • Don't leave any required fields blank; incomplete forms may lead to delays or rejection.
  • Don't submit the form late; it must be filed within 10 days of execution to be valid.
  • Don't forget to keep copies of the signed agreement for both the Hiring Contractor and the Independent Contractor for record-keeping purposes.

Key takeaways

Understanding the DWC 83 form is crucial for both hiring contractors and independent contractors in Texas. Here are some key takeaways to consider when filling out and using this form:

  • Consultation is Key: Before entering into any agreement, ensure that all parties meet the qualifications of an independent contractor as defined by Texas law. Consulting an attorney can provide clarity and protect your interests.
  • Independent Contractor Definition: According to Texas Labor Code, an independent contractor is someone who is paid by the job, can hire their own helpers, and can work for multiple contractors simultaneously.
  • Joint Agreement Requirement: Both the hiring contractor and the independent contractor must sign the form to affirm their independent relationship, which is essential for avoiding workers’ compensation liabilities.
  • Coverage Implications: By signing the DWC 83 form, the independent contractor and their employees will not be entitled to workers' compensation coverage from the hiring contractor.
  • Timeliness Matters: The declaration takes effect upon receipt by the Texas Department of Insurance. Ensure that the form is filed promptly to avoid complications.
  • Notification of Changes: If a new hiring agreement is made that does not apply under this declaration, both parties must notify the Texas Department of Insurance and the hiring contractor's insurance carrier within 10 days.
  • Multiple Copies Required: Four copies of the DWC 83 form must be completed. The original must be filed with the Texas Department of Insurance, while copies should be retained by both parties.
  • Delivery Method: The form must be submitted by personal delivery or through registered or certified mail to ensure proper filing and receipt.

Staying informed about the DWC 83 form can help you navigate the complexities of independent contractor agreements in Texas. Take action now to ensure compliance and protect your rights.

Document Preview Example

TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION

7551 Metro Center Drive, Suite 100

Austin, Texas 78744

If you are not certain whether all parties meet the requirements for entering into this agreement, you may wish to consult an attorney.

Texas Workers' Compensation Act, Texas Labor Code, Section 406.141(2) defines "independent contractor" as follows: (2) "Independent contractor" means a person who contracts to perform work or

provide a service for the benefit of another and who: (A) is paid by the job, not by the hour or some other time-measured basis; (B) is free to hire as many helpers as he desires and to determine what each helper will be paid; and (C) is free to work for other contractors, or to send helpers to work for other contractors, while under contract to the hiring employer.

CHECK BOX OF STATEMENT THAT APPLIES

JOINT AGREEMENT TO AFFIRM INDEPENDENT

RELATIONSHIP FOR CERTAIN BUILDING

AND CONSTRUCTION WORKERS

Notice of Declaration

The undersigned Hiring Contractor and the undersigned Independent Contractor hereby declare that the Independent Contractor meets the qualifications of an Independent Contractor under Texas Workers' Compensation Act, Texas Labor Code, Section 406.141, that the Independent Contractor is not an employee of the Hiring Contractor, and that:

(A)the Independent Contractor and the Independent Contractor's employees shall not be entitled to workers' compensation coverage from the Hiring Contractor; and

(B)the Hiring Contractor's workers' compensation insurance carrier shall not require premiums to be paid by the Hiring Contractor for coverage of the Independent Contractor or the Independent Contractor's employees,

helpers, or subcontractors.

__________________________________________________________________

THIS DECLARATION TAKES EFFECT UPON RECEIPT BY THE TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION. THIS DECLARATION APPLIES TO ALL HIRING AGREEMENTS EXECUTED BY THE HIRING CONTRACTOR AND THE INDEPENDENT CONTRACTOR DURING THE YEAR AFTER THIS DECLARATION IS FILED UNLESS A SUBSEQUENT HIRING AGREEMENT IS MADE TO WHICH THE DECLARATION DOES NOT APPLY. IN THE EVENT THAT A HIRING AGREEMENT TO WHICH THIS DECLARATION DOES NOT APPLY IS MADE, THE HIRING CONTRACTOR AND INDEPENDENT CONTRACTOR SHALL SO NOTIFY THE TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION AND THE HIRING CONTRACTOR'S WORKERS' COMPENSATION INSURANCE CARRIER (IF ANY) IN WRITING WITHIN 10 DAYS AFTER THE NON-APPLYING AGREEMENT IS MADE. ONCE THIS AGREEMENT IS SIGNED, THE SUBCONTRACTOR AND THE SUBCONTRACTOR'S EMPLOYEES SHALL NOT BE ENTITLED TO WORKERS' COMPENSATION COVERAGE FROM THE HIRING CONTRACTOR UNLESS A SUBSEQUENT WRITTEN AGREEMENT IS EXECUTED, AND FILED ACCORDING TO WORKERS’ COMPENSATION RULES, EXPRESSLY STATING THAT THIS AGREEMENT DOES NOT APPLY.

AGREEMENT TO ESTABLISH EMPLOYER- EMPLOYEE RELATIONSHIP FOR CERTAIN BUILDING AND CONSTRUCTION WORKERS

Notice of Agreement

The undersigned Hiring Contractor and the undersigned Independent Contractor hereby agree

that the Hiring Contractor will withhold will not withhold the cost of workers' compensation insurance coverage from the Independent Contractor's contract price and that the Hiring Contractor will purchase workers' compensation insurance coverage for the Independent Contractor and the Independent Contractor's employees. Once this agreement is signed, for the purpose of providing workers' compensation insurance coverage, the Hiring Contractor will be the employer of the Independent Contractor and the Independent Contractor's employees. This agreement makes the Hiring Contractor the employer of the Independent Contractor and the Independent Contractor's employees only for the purposes of workers' compensation laws of Texas and for no other purpose.

TERM (DATES) OF AGREEMENT:

FROM: _____________________

 

TO: ________________________

LOCATION OF EACH AFFECTED JOB SITE (OR STATE WHETHER THIS IS A BLANKET AGREEMENT):

_________________________________________________________________

__________________________________________________________________

___________________________________________________________________

ESTIMATED NUMBER OF EMPLOYEES AFFECTED: _________________

THIS AGREEMENT SHALL TAKE EFFECT NO SOONER THAN THE DATE IT IS SIGNED.

Hiring Contractor's Affirmation

If the Hiring Contractor's workers' compensation carrier change

 

during the effective period of coverage, it is advisable for the Hiring Contractor

__________________________________

to file this form with the new insurance carrier.

 

Federal Tax I.D. Number

______________________________________________

______________________

________________________________________________________________

Signature of Hiring Contractor

Date

Address (Street)

________________________________________________________________________

________________________________________________________________

Printed Name of the Hiring Contractor

 

Address (City, State, Zip)

 

Independent Contractor's Affirmation

____________________________

 

 

 

Federal Tax I.D. Number

______________________________________________

______________________

________________________________________________________________

Signature of Independent Contractor

Date

Address (Street)

 

________________________________________________________________________

________________________________________________________________

Printed Name of the Independent Contractor

 

Address (City, State, Zip)

 

Four copies of this form must be completed: This agreement must be filed by the Hiring Contractor with both the Texas Department of Insurance, Division of Workers’ Compensation and the workers’ compensation insurance carrier of the Hiring Contractor within 10 days of the date of execution. The original must be filed with the Division. The agreement must be filed by PERSONAL DELIVERY OR REGISTERED OR CERTIFIED MAIL. Both the Hiring Contractor and the Independent Contractor must also retain a copy of the agreement.

Division Date Stamp Here

DWC FORM-83 (Rev. 10/05)

DIVISION OF WORKERS’ COMPENSATION

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Misconceptions

Understanding the DWC 83 form can be challenging, and there are several misconceptions that can lead to confusion. Here are six common misunderstandings:

  • Misconception 1: The DWC 83 form is only for employees.
  • This form is specifically designed for independent contractors. It clarifies the relationship between the hiring contractor and the independent contractor, ensuring that the latter is not considered an employee for workers' compensation purposes.

  • Misconception 2: Filing the DWC 83 form guarantees workers' compensation coverage.
  • Filing this form does not provide workers' compensation coverage. Instead, it states that the independent contractor and their employees will not receive coverage from the hiring contractor's insurance.

  • Misconception 3: The DWC 83 form is a one-time requirement.
  • This form must be filed for each hiring agreement. If a new agreement is made that does not apply to the previous declaration, both parties must notify the Texas Department of Insurance within ten days.

  • Misconception 4: Only the hiring contractor needs to sign the form.
  • Both the hiring contractor and the independent contractor must sign the DWC 83 form. Their signatures affirm the understanding of their relationship regarding workers' compensation.

  • Misconception 5: The DWC 83 form can be submitted electronically.
  • This form must be filed by personal delivery or registered/certified mail. Electronic submissions are not accepted, ensuring that there is a physical record of the filing.

  • Misconception 6: The DWC 83 form is only relevant for specific industries.
  • While commonly used in building and construction, the DWC 83 form applies to any independent contractor relationship under Texas law. It is essential for any contractor wishing to clarify their status.