DWC084 at a glance
What it is: DWC084 is for a hiring agreement that should not be included in the terms of a joint agreement on DWC Form-083.
Who signs: The hiring contractor signs in Box 11; the independent contractor signs in Box 18.
The hiring contractor must complete Part 2 and the independent contractor must complete Part 3.
Texas Labor Code Section 406.141(2) defines an independent contractor as a person who contracts to perform work or provide a service for the benefit of another, and who is paid by the job, not by the hour or some other time-measured basis; free to hire as many helpers as desired and determine what to pay each helper; and free to work for other contractors or send helpers to work for other contractors, while under contract with the hiring employer.
A filled-in DWC084 example: a hiring contractor and an independent contractor
How to fill out DWC084, box by box
Part 1. Agreement
In Box 1, enter the start date of the joint agreement to affirm independent relationship for certain building and construction workers (mm/dd/yyyy).
In Box 2, enter the date of the hiring agreement (mm/dd/yyyy); the date must be later than the date in Box 1.
Location of job sites the agreement does not affect
Under Location of job sites the agreement does not affect, enter in Box 3, Box 4 and Box 5 an address (street or PO box, city, state, ZIP code).
Attach a sheet with additional locations if needed.
Part 2. The hiring contractor must complete this part
The hiring contractor must complete Part 2: enter the hiring contractor name in Box 6 and the federal tax ID number in Box 7.
In Box 8, enter the address (street or PO box, city, state, ZIP code); in Box 9, enter the email.
In Box 10, the hiring contractor declares that the joint agreement, as recorded on DWC Form-083, does not apply to the hiring agreement (dated in Box 2) between the hiring contractor and independent contractor, and that nothing in this declaration will undo the joint agreement as it applies to other hiring agreements made during the term of the joint agreement.
In Box 11, the hiring contractor signs; in Box 12, enter the date of signature (mm/dd/yyyy).
Part 3. The independent contractor must complete this part
The independent contractor must complete Part 3: enter the independent contractor name in Box 13 and the federal tax ID number in Box 14.
In Box 15, enter the address (street or PO box, city, state, ZIP code); in Box 16, enter the email.
The independent contractor declares that the joint agreement, as recorded on DWC Form-083, does not apply to the subsequent hiring agreement (dated in Box 2) between the hiring contractor and independent contractor, and that nothing in this declaration will undo the joint agreement as it applies to other hiring agreements made during the term of the joint agreement.
In Box 18, the independent contractor signs; in Box 19, enter the date of signature (mm/dd/yyyy).
More rules for DWC084
The agreement takes effect on the date both parties have signed it.
The hiring contractor must keep the original. The independent contractor should also keep a copy.
You may want to talk to an attorney if you are not sure if all parties meet the requirements to enter into these agreements.
The signed agreement and the insurance carrier
The hiring contractor files the signed agreement with its workers' compensation insurance carrier
The hiring contractor must file a legible and complete copy of this agreement with their workers' compensation insurance carrier within 10 days after signing the agreement.
If the hiring contractor changes workers' compensation insurance carriers during the effective dates of the agreement, the hiring contractor should file this form with their new insurance carrier.
Do not send a copy to the Texas Department of Insurance, Division of Workers' Compensation (DWC).
Sources
[1] Form DWC084 (Rev. 10/21), Exception to application of joint agreement to affirm independent relationship for certain building and construction workers, Texas Department of Insurance, Division of Workers' Compensation (the Official source link on this page).