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Employer's Wage Statement

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(DWC-3) Form

What is the Employer's Statement of Wage Earnings (DWC-3) Form designed to accomplish?

The Texas Workers' Compensation Act provides for payment of weekly income benefits in certain instances. The rate of compensation to which an employee is entitled is based upon his or her average weekly wage as defined in the law. The information in the Employer's Statement of Wage Earnings Form (DWC-3) is necessary to properly calculate the employee's average weekly wage.

When does the Employer's Statement of Wage Earnings (DWC-3) Form need to be completed and filed?

The DWC-3 is required whenever the employing department knows or should know that an injured employee has missed one day of work. The University of Texas System employers must file a signed statement with The University of Texas System Workers' Compensation Insurance third party administrator within seven days for any claim with one day of lost time or more to ensure accurate wage reporting and timely and accurate payment of benefits. The DWC-3 may be electronically filed with CCMSI utilizing iCE .

Process of completing and filing the Employer's Statement of Wage Earnings (DWC-3) Form-

If the injured employee was not employed by the institution listed in Item #5 for the 13-week period immediately preceding the injury, then a "similar employee" who performs similar service should be identified. Use Item #11 (Salary/Wages) on the form to list the similar employee's wages for the 13-week period immediately preceding the injury date. "Similar employee" means an employee with training, experience and skills comparable to the injured employee. Age, gender and race are not to be considered. A "similar employee" does not necessarily earn the same wages as the injured employee.

Information for Item#11 (Salary/Wages) and Item #12 (Fringe Benefits)-

In Item #11, include the gross amount of all money paid as wages or salary. Also, include money paid to the employee even if the employee was not on the job; such as sick leave, vacation, holidays or if actually paid during the 13-week period reported on the wage statement. Do not include money counted in Item #12 (Fringe Benefits). In Item #12, do not include money counted in Item #11. Check each item to indicate whether or not this was regularly included in the employee's pay. Include any payment or gain that is not on the list in the "other" box. (Longevity pay should not be included here. It should be included in Item #11). Give the actual amount if known. Estimate the amount if the actual amount is not know.

Important Information

Accrued vacation and sick leave is not reported. Only vacation and sick leave that has actually been paid during the 13-week period preceding the date of injury should be reported on this form.

Administrative Penalty

Employers who fail to file a complete wage statement without good cause may be assessed an administrative penalty not to exceed $500 per record.