Dwc Form 84 PDF Details

In the intricate tapestry of employment and labor law within Texas, the DWC 84 form represents a significant thread, particularly in the building and construction sector. This document, emanating from the Texas Department of Insurance, Division of Workers' Compensation (DWC), plays a pivotal role in delineating the relationship between hiring contractors and independent contractors. Specifically designed to be an exception to the joint agreement outlined in DWC FORM-83, it clearly stipulates the conditions under which the stipulated independent relationship for building and construction workers does not apply to certain hiring agreements. This form not only exempts specific job agreements from the broader umbrella of the joint agreement but also carefully delineates provisions that maintain the validity of the joint agreement for other hiring relationships under its term. It is crucial for hiring contractors, when there’s a change in their workers' compensation insurance carrier, to file this form with their new carrier to ensure continued compliance with the Texas Labor Code, Texas Workers’ Compensation Act, Section 406.145. By mandating the submission of a legible copy of this agreement to the hiring contractor’s workers' compensation insurance carrier within a defined timeframe, the DWC 84 underscores the seriousness of maintaining accurate and accessible records of independent contractor agreements in Texas. Furthermore, this requirement emphasizes the need for both hiring contractors and independent contractors to retain copies of the agreement, ensuring both parties are clear about their rights and obligations within this specified working relationship.

QuestionAnswer
Form NameDwc Form 84
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesadvisable, tx dwc 84, nullifies, dwc

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TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION (DWC)

7551 Metro Center Drive, Suite 100

Austin, Texas 78744

DO NOT SEND THIS AGREEMENT TO DWC

EXCEPTION TO APPLICATION OF JOINT AGREEMENT TO AFFIRM INDEPENDENT

RELATIONSHIP FOR CERTAIN BUILDING AND CONSTRUCTION WORKERS

NOTICE OF DECLARATION

The undersigned Hiring Contractor and the undersigned Independent Contractor declare that the Joint Agreement to Affirm Independent Relationship for Certain Building and Construction Workers (as recorded on DWC FORM-83) does not apply to the subsequent hiring agreement between the Hiring Contractor and Independent Contractor. Nothing in this declaration otherwise nullifies the Joint Agreement to Affirm Independent Relationship for Certain Building and Construction Workers as it applies to other hiring agreements made during the term of the joint agreement.

DATE OF JOINT AGREEMENT TO AFFIRM INDEPENDENT RELATIONSHIP FOR CERTAIN BUILDING AND CONSTRUCTION WORKERS

LOCATION OF SPECIFIC JOB SITES NOT AFFECTED BY JOINT AGREEMENT:

DATE OF SUBSEQUENT HIRING AGREEMENT TO WHICH THIS FORM APPLIES

NAME OF HIRING CONTRACTOR

NAME OF INDEPENDENT CONTRACTOR

Texas Labor Code, Texas Workers’ Compensation Act, Section 406.145.

Hiring Contractor’s Affirmation

If the Hiring Contractor’s workers’ compensation carrier changes

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 Hiring Contractor

 

 

Address (City, State, Zip)

Independent Contractor’s Affirmation

Signature of Independent Contractor

Date

Printed Name of Independent Contractor

Federal Tax I.D. Number

Address (Street)

Address (City, State, Zip)

The Hiring Contractor must retain the original. A legible copy of this agreement must be filed with the hiring contractor’s workers’ compensation insurance carrier within 10 days of the date of execution. An agreement is not considered filed if it is illegible or incomplete. The Independent Contractor should also retain a copy of the agreement.

DWC FORM-84 REV. 01/21

DIVISION OF WORKERS’ COMPENSATION

How to Edit Dwc Form 84 Online for Free

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How you can complete texas form84 step 1

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texas form84 writing process explained (step 2)

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