March 14, 2006

Updated Texas Nonsubscriber Forms and Notices
Required by the Division of Workers' Compensation

Forms and notices used by Texas nonsubscribers were updated recently to reflect the new administration by the Texas Department of Insurance (TDI), Division of Workers' Compensation (DWC) - formerly adminstered by the Texas Workers' Compensation Commission. The mandatory date to begin using the revised DWC forms is May 1, 2006, although nonsubscribers may begin using the new forms immediately. The new forms and their uses are listed below:

New Name	Previously	Use
DWC Form 5	TWCC 5	Notice to State of Texas: Notifies the DWC if a business chooses to become a nonsubscriber. This form must be filed initially within 10 days after notifying the insurance carrier of cancellation and annually on the anniversary date of the original filing.
DWC Form 205	TWCC 205	Lists additional business locations of a nonsubscriber. Used in conjunction with DWC Form 5 above.
DWC Notice 5 DWC Notice 5s	TWCC Notice 5 TWCC Notice 5s	Notice to Employees and Workplace Posters: Notifies employees of employer's nonsubscriber status. This notice must be posted in the workplace in English, Spanish, and other language common to the workplace within 15 days of the employer dropping or canceling insurance coverage. Written notice must also be distributed to all Texas employees using this same language.
DWC Form 7 DWC Form 7s	TWCC 7 TWCC 7 Supp.	Lost Time/OD/Death Claim Notice: Reports all fatalities, occupational diseases, and on-the-job injuries resulting in more than one day's abscense from work for the injured employee. Must be filed no later than the 7th day of the month following the reported incident.