FAQ

Accident prevention services annual report

Who must file the DWC Form-109?

An insurance company writing workers’ compensation insurance in Texas must file the DWC Form-109 with DWC as an annual report of its accident prevention services. Insurance companies must file the DWC Form-109 accurately and on time. A DWC Form-109 is considered filed with DWC only when it contains all required information.

When do I file the initial DWC Form-109?

An insurance company must file the DWC Form-109 as its initial report by the effective date of its first workers’ compensation policy:

• If it writes its first workers’ compensation insurance policy in Texas on or after September 1, 2013; or
• When it resumes writing workers’ compensation insurance in Texas and has not written workers’ compensation insurance with exposures in Texas for 12 or more months.

When do I file the subsequent DWC Form-109?

An insurance company must file each subsequent DWC Form-109 by April 1 of each year.

How do I file the DWC Form-109?

You must send the DWC Form-109 to [email protected].

Are any fields on the DWC Form-109 optional?

No, you must complete all applicable fields each time you file the DWC Form-109. For subsequent filings, some fields only require information that has changed since the last filing.

Note: With few exceptions, on your request, you are entitled to:

• Be informed about the information DWC collects about you.
• Receive and review the information (Government Code Sections 552.021 and 552.023).
• Have DWC correct information that is incorrect (Government Code Section 559.004).

For more information, contact [email protected] or refer to the Corrections Procedure section at www.tdi.texas.gov/commissioner/legal/lccorprc.html.