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DWC-3 overview

A DWC-3 is an Employer's Wage Statement form outlined by the Texas Department of Insurance, Division of Workers' Compensation (DWC). Texas Mutual uses this form to determine the injured employee's average weekly wage and calculate financial assistance for them or their beneficiary. Your claims partner/adjuster will let you know if you need to complete this form.

Average weekly wage:

The average weekly wage (AWW) is used to determine an injured employee's income benefits. Read more Our online DWC-3 can calculate the AWW for most injured employees when you enter 12 to 14 weeks of their pay. * If the employee did not work 13 weeks before the incident, we can calculate the AWW based on the earnings of an employee with the same or similar job.

*The AWW is calculated differently for school district employees. If you need to submit a DWC-3 for an injured school district employee, your adjuster can help you complete the paper DWC-3 form quickly and accurately.

Timely filing:

Texas Mutual must receive your DWC-3 within 30 days of the earliest of:

  1. the employee's eighth day of disability;
  2. the date you're notified that the employee is entitled to income benefits;
  3. the date of the of the employee's death as a result of a compensable injury.

Eligibility for online DWC-3:

Most DWC-3 submissions can be done online. Read more

However, in some instances, such as the injured employee was hurt while working at another job, or if they are a school district employee, you will need to complete a paper DWC-3 form. You can find the DWC-3 form on the Employer Forms section of our website.

For those that can be submitted online, you can either:

  • Log in to TMO and find the DWC-3 link in the injured employee's claim details page.
  • Visit texasmutual.com/dwc-3 and enter the injured employee's claim number, date of birth, and date of hire or date of injury.

Filling out an online DWC-3

The DWC-3 will ask about different types of wages, as well as payment dates and frequency. It's very important to provide exact data so we can correctly calculate the average weekly wage. We recommend having pay stubs with you while you complete the form. Read more

Information you'll need to gather:

1.    The injured employee's date of hire, and if applicable, their return-to-work date and if they have any restrictions. 2.    All hours worked and wages paid before and after the injury, including:
Hours and frequency: How many hours did the employee work each pay period?
Gross wages
(not net wages):		 How much money did the employee earn before deductions?
3.    The date any wages were discontinued, if applicable.
If employee was paid... Gather pay stubs from before the injury for...
1 to 2 times a month on fixed dates 3 months
Every other week 14 weeks
Other frequency 13 weeks

Unavailable wage information:

If you do not have enough payroll information for the injured employee, you can use data from an employee with a similar role. The similar employee should have training, experience, skills and wages comparable to the injured employee and perform similar duties. If no similar employee exists, report what information you do have. If you need any assistance, we're here to help you.

DWC-3 online form is broken into 8 sections:

  1. Employee information: Previously reported information about the injured employee (name, date of birth, etc.) will show in this section. We encourage you to complete as many details on this page and throughout to make processing most efficient.
  2. Wage qualifying questions: We need to know how often the employee worked and was paid to calculate how many weeks of wages are needed. If the employee has returned to work, you will also need to share if they have restrictions and their average earnings per pay period.
  3. Pecuniary wage types: Besides gross wages, what other monetary forms of payment did the employee receive? This can be bonuses, tips, gratuities, etc.
  4. Pecuniary wage information: All the pecuniary wage types you select will appear here for you to enter wages for each. If it's the same across pay periods, you can use the autofill feature to copy the info from the first row to subsequent rows. You can also overwrite the copied data to input new data.
  5. Wage verification: If you enter a pay period with no income, this is your opportunity to explain why the employee was not paid during this time.
  6. Non-pecuniary wage types: What benefits and perks (such as health insurance, uniforms, housing/lodging, etc.) did the employee receive not in the form of money? This does not include reimbursements paid to the employee.
  7. Non-pecuniary wage type review: After listing the non-monetary benefits, you will be asked to indicate which were provided before and after the injury, and which have been suspended.
  8. Attestation and submission: After completing the form, you must certify its accuracy before submitting.

Saving drafts of your online DWC-3

You can save your DWC-3 draft at any time during the process by selecting the save button. We will save your draft for 30 days. Three days before your draft expires, we will send you a reminder email. The draft is tied to the claim number, so to get back to a saved draft, simply follow the same instructions on how to start a DWC-3.

For more help

We are with you every step of the way. If you have any questions about completing the DWC-3 or a claim, please contact your adjuster, who is your claim partner, or call us at (800) 859-5995.