dwc-003 form is the common name for Texas DWC Form-003, the Employer’s Wage Statement. Your employer fills it out, not you. It lists what you earned before you got hurt. The insurance carrier uses it to figure out your weekly benefit. If you are hurt and worried about money, this form matters to you. It helps decide how much your checks will be.
What the Dwc-003 Form Is For
Texas workers’ comp pays income benefits based on your average weekly wage. That is the average amount you earned per week before your injury. However, the carrier does not know your pay history on its own. It needs your employer to report it. The dwc-003 form is how your employer does that. It records your wages for the weeks before you got hurt.
The form can also list non-cash pay. For example, health insurance your employer paid for may count. In most cases, an accurate wage statement leads to a fair benefit amount. As a result, a missing or wrong form can mean lower checks than you may be owed. The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) publishes the form. Here are the key facts:
| Item | Details |
|---|---|
| Form number | DWC Form-003 |
| Form title | Employer’s Wage Statement |
| Who files | The employer, to the carrier and the worker, within 30 days of the carrier’s request |
| Where it goes | To the insurance carrier and to the injured worker |
| Fee | The form is free to download from TDI-DWC; confirm any cost questions with the agency |
| Agency | Texas Department of Insurance, Division of Workers’ Compensation |
| Official PDF | DWC Form-003 official PDF |
Who Files the Dwc-003 Form and When
Your employer files the dwc-003 form. You do not have to fill it out yourself. Typically, the process starts after you report your injury. The carrier then asks your employer for your wage details. Your employer must complete the form and send copies out. One copy goes to the carrier. Another copy goes to you.
Keep in mind this clock starts with the carrier’s request. It does not start on the day you got hurt. That is a separate step in the claim process. If you have not filed yet, read our guide on how to file a Texas workers comp claim. You can also review the basic Texas workers comp requirements to see which deadlines apply to you.
What if your employer is late? Don’t panic. Many workers find the delay is simple paperwork backlog. However, you can contact the carrier and ask about the status. You can also reach out to TDI-DWC for help. The agency has staff who assist injured workers without a lawyer.
How to Fill It Out and Where to Send It
The employer fills in the dwc-003 form with basic facts. These include your name, the employer’s name, and the carrier’s details. Then comes the wage history. The employer lists your pay for each week before the injury. It also notes any non-cash benefits it provided. If you worked fewer weeks, the form has rules for that too. The instructions on the form explain each section.
Common mistakes can lower your benefit. Watch for these problems on the dwc-003 form:
- Missing weeks or wrong pay amounts.
- Overtime left off the list.
- Health insurance or other non-cash pay not reported.
- Wrong injury date, which shifts the weeks counted.
- No copy sent to you, the worker.
The employer sends the completed form to the carrier and to you. Ask the carrier how it prefers to receive it, such as mail, fax, or email. You can download the official DWC Form-003 PDF to see the blank version. TDI-DWC lists it with other forms on its official Texas workers’ comp forms page. Compare your own pay stubs to what your employer wrote.
What Happens After You File
Once the carrier has the dwc-003 form, it uses the wages to figure your average weekly wage. That number drives your weekly income benefits. Typically, the carrier will tell you the benefit rate it set. If the numbers look low, you are not stuck. You may be entitled to dispute the wage figure. Gather pay stubs, tax records, or bank deposits to show your true earnings.
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You can raise wage questions with the carrier first. If that does not fix it, TDI-DWC can help. The agency runs a dispute process for injured workers. To learn who does what, see our overview of the Texas workers comp board. Confirm every figure and deadline with TDI-DWC and a licensed attorney before you act. Every case is different.
Frequently Asked Questions
Do I have to fill out the dwc-003 form myself?
No. Your employer is the one who completes and files it. However, you should get a copy. Read it closely and check it against your pay records.
What if my dwc-003 form shows the wrong wages?
First, contact the carrier and explain the error. Send proof, such as pay stubs or tax forms. If the carrier does not correct it, TDI-DWC can help you through the dispute process.
What if my employer never sends the dwc-003 form?
The employer must send it within 30 days of the carrier’s request. If it is late, ask the carrier for an update. You can also contact TDI-DWC for help, and a licensed attorney can review your options.
Dwc-003 form: Quick Recap
If you remember one thing about dwc-003 form, make it this: the rule is set by the state (or the federal program), not by the insurer, and the official source is linked above. Every figure on this page about dwc-003 form should be confirmed with the agency before you act on it.
Questions about dwc-003 form that this page does not answer are usually answered for free by the state workers’ comp agency’s information line — and, for a disputed claim, by a licensed attorney in a first consultation.
See your state’s exact numbers
What you are owed depends on your state’s benefit caps and deadlines. Start with your state’s settlement and claim guides for the exact figures.
Sources & How to Verify
The figures on this page come from official government and industry sources. Workers’ comp benefit caps, deadlines, and rules change, so always confirm the exact figure with your state’s workers’ comp board or a licensed attorney before acting. Settlement estimates are illustrative, and every case is different.
- Your state workers’ comp board, division, or commission: the official source for your state’s exact caps, deadlines, and forms — search “[your state] workers compensation board”
- U.S. Department of Labor (OWCP): dol.gov — federal workers’ compensation overview
- NCCI: ncci.com — workers’ comp rating and benefit data
- Social Security Administration: ssa.gov — benefit-cap and SSDI offset data
- Insurance Information Institute: iii.org — neutral workers’ comp background
Content last reviewed October 2026. If you notice an outdated figure, please contact us.
Related Guides
- Texas Workers Comp Board
- How to File a Texas Workers Comp Claim
- Texas Workers Comp Requirements
- Workers Comp Settlements by State (All 50)
- Workers Comp Claims by State (All 50)
- More in This Category
- Settlements by Injury
- Benefits Explained
- Workers Comp Glossary
Informational only — not legal, medical, or financial advice. Workers Comp Explained is an independent educational resource, not a law firm, insurer, or medical or financial advisor, and this page does not provide legal, medical, or financial advice. Workers’ compensation benefits, deadlines, and rules vary by state and change over time, and settlement estimates are illustrative only. Always confirm the exact figure and any deadline with your state’s workers’ compensation board and a licensed attorney before you act.