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Public insurance adjuster bond licensing certifies that the persons listed on the form are bound to the texas department of insurance in the sum of 10 000 as specified at 28 texas administrative code 19 705.
Texas dept of insurance form dwc005. La versión en español está disponible en. Box 149104 austin tx 78714 512 676 6000 800 578 4677. Dwc005 employer notice of. You must file the dwc form 005 if you.
Box 149104 austin tx 78714. Division of workers compensation main forms page self insured employer forms and required coverage notices. Texas department of insurance. Call the texas department of insurance at 512 676 6500.
Division of workers compensation insurance coverage ms 96 7551 metro center drive suite 100 austin texas 78744 1645 800 252 7031 f. Texas department of insurance 333 guadalupe austin tx 78701 p o. Texas department of insurance 333 guadalupe austin tx 78701 p o. Texas department of insurance 333 guadalupe austin tx 78701 p o.
If an employer discontinues its workers compensation coverage it must inform employees and the workers compensation division of the texas department of insurance as soon as possible via a form dwc005 pdf. Texas department of insurance tdi dwc form 005 information about completing the form for those who submit forms on behalf of others and wish to file one or more submissions of a particular dwc form a file in xml format may be submitted. You also might be able to get your answer by going to the texas department of insurance s website. Have a payment or insurance license question.
Need help with this website. Do not have workers compensation insurance or you have terminated your workers compensation insurance coverage however if your only employees are exempt from coverage under the texas workers compensation act for example certain domestic workers certain farm and ranch workers you do not have to file. Employer notice of no coverage or termination of coverage. 512 804 4146 tdi texas gov texastdi.
Division of workers compensation subject.
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