Employers Report For Reimbursement Of Voluntary Payment {DWC-2}

DWC002 - EMPLOYER’S REPORT FOR REIMBURSEMENT OF VOLUNTARY PAYMENT. This form is used by employers in Texas to request reimbursement from their workers’ compensation insurance carrier for voluntary payments made to an injured employee. Send a copy of this form to the Texas Department of Insurance, Division of Workers’ Compensation (DWC) and the insurance carrier. You can fax or mail the completed form to DWC or drop the form off at a DWC field office. Send the form within seven days after the date of first payment. An employer should also timely file the DWC Form-001, Employer’s First report of injury or illness as Texas Labor Code Section 409.005 requires. If you fail to do this, it will waive your right to reimbursement of any voluntary payments. The insurance carrier should reimburse the employer within seven days after receiving the request. The insurance carrier should notify DWC within seven days of reimbursing the employer the amount reimbursed and the date of the reimbursement. If there is a dispute concerning reimbursement, the employer may file a subclaim in accordance with Labor Code Section 409.009. www.FormsWorkflow.com