Use this form when there is a hiring agreement that should not be included in the terms of a joint agreement on DWC Form-083.
Where to file: the hiring contractor must file a legible and complete copy with their workers' compensation insurance carrier within 10 days after signing the agreement.
Do not send: do not send a copy to the Texas Department of Insurance, Division of Workers' Compensation (DWC).
Effective: the agreement takes effect on the date both parties have signed it.
Keep: the hiring contractor must keep the original; the independent contractor should also keep a copy.
Who completes: the hiring contractor must complete Part 2; the independent contractor must complete Part 3.
| Question | Answer |
|---|---|
| Form Name | Form DWC084 |
| Form Length | 3 pages |
| Fillable? | Yes |
| Fillable fields | 17 |
| Avg. time to fill out | 3 min |
| Edition | Rev 10/21 |
| Issuing agency | Texas Department of Insurance, Division of Workers' Compensation |
| Filing deadline | The hiring contractor must file within 10 days after signing the agreement |
| Matches the agency's file | Yes, checked October 3, 2026 |
| Other names | DWC084, DWC 84, DWC-84, Form 84, DWC Form 84, Exception to application of joint agreement |
| Official source | Form DWC084 (Rev 10/21), Texas Department of Insurance, Division of Workers' Compensation |
Dwc Form 84 isn’t the one you’re looking for?