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Form Dwc005 Employer Notice Of No Coverage Or Termination Of Coverage - Texas Department Of Insurance Division Of Workers' Compensation Page 2

DWC005

Frequently Asked Questions

Employer Notice of No Coverage or Termination of Coverage

Who must file the DWC Form-005?

An employer who does not have workers’ compensation insurance (non-subscriber) must file the DWC

Form-005, unless the employer’s only employees are exempt from coverage under the Texas Workers’

Compensation Act (for example, certain domestic workers, certain farm and ranch workers).

An employer who terminates workers’ compensation insurance coverage must file the DWC Form-005.

Failure to file the form when required may subject the employer to administrative penalties.

When do I file the DWC Form-005?

An employer who uses the DWC Form-005 to file a notice of no coverage must file:

annually between February 1st and April 30th of each calendar year;

within 30 days of the employer hiring its first employee, unless this due date falls between

February 1st and April 30th and the employer submits the notice within this time period; and

within 10 days of receipt of a TDI-DWC request for filing a notice of no coverage.

An employer who uses the DWC Form-005 to file a notice of termination of coverage must file:

within 10 days after notifying the insurance carrier of the termination of coverage unless

the employer purchases a new policy or becomes a certified self-insurer; and

thereafter, the employer must file the DWC Form-005 as a non-subscriber as long as the

employer remains in operation and does not have workers’ compensation insurance

coverage.

How do I file the DWC Form-005?

Employers can submit the DWC Form-005 to the TDI-DWC by:

filing electronically on the TDI website at:

https://txcomp.tdi.state.tx.us/TXCOMPWeb/common/home.jsp;

faxing the form to (512) 804-4146; or

mailing the form to the address listed at the top of the form (if the filing is for termination of

coverage, the submission must be by certified mail).

How/when must a non-subscriber notify employees that workers’ compensation coverage is not

provided?

An employer must post the Notice to Employees Concerning Workers’ Compensation in Texas in the

workplace in English, Spanish and any other language common to the employer’s employee population

in the print type specified by TDI-DWC rules whenever the employer:

elects to not have workers' compensation insurance;

cancels or terminates workers' compensation insurance;

withdraws from certified self-insurance; or

has its workers' compensation coverage cancelled by the insurance company.

DWC005 Rev. 01/13

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TX Insert 1 of 6

Form Dwc005 Employer Notice Of No Coverage Or Termination Of Coverage - Texas Department Of Insurance Division Of Workers' Compensation Page 2