Instafill.ai
7 days free
AI form filling · 30 fields · 2 pages · done in seconds

Yes! You can use AI to fill out DWC002, Employer’s report for reimbursement of voluntary payment

Don't type 30 fields by hand. Tell our AI about yourself, or upload a document you already have, and it fills every field in seconds. You check it, then download, print or sign.

7 days free, then $19.99/month · Cancel anytime
AI fills it, no typingEncrypted, never used to train AICancel in two clicks
DWC002, Employer’s report for reimbursement of voluntary payment, page 1
Basic · 39/100Form Complexity Index

The AI does the filling. You just check it.

No typing into boxes, nothing to install.

Tell the AI about youAnswer a few questions in plain words, or upload a document you already have. That is all the typing there is.
AI fills every field in secondsIt puts each answer in the right box on every page, checkboxes included.
Check it and downloadReview every field, change anything, then download, print or sign the PDF.

What this form asks for

The AI fills all of it, from your answers or your documents.

Form DWC002, Employer’s Report for Reimbursement of Voluntary Payment, is a document used in Texas by an employer to seek reimbursement from their insurance carrier for payments made directly to an injured employee. These voluntary payments can cover initial medical expenses or supplement income before the official workers' compensation claim is processed. Filing this form correctly and promptly is crucial for an employer to recover their costs. Today, this form can be filled out quickly and accurately using AI-powered services like Instafill.ai, which can also convert non-fillable PDF versions into interactive fillable forms.
Fillable fields30
Pages2
Sections9
Form Complexity IndexBasic, 39/100

The AI checks your answers before you download

12 checks built for this form, so a wrong date or a missing answer is caught before anyone else sees it.

Validates SSN Last Four Digits Format

This check ensures that the 'Social Security number (last four digits)' field contains exactly four numeric characters. This is crucial for correctly identifying the employee while maintaining privacy standards required by law. A failure in this validation would prevent the form from being processed, as the employee cannot be uniquely and securely identified in the system.

Ensures Date of Injury is Not in the Future

This validation confirms that the 'Date of injury' is a valid date in MM/DD/YYYY format and occurs on or before the current submission date. An injury cannot have happened in the future, so this check prevents logical impossibilities and common data entry errors. If the date is invalid or in the future, the submission will be rejected to ensure the claim's temporal accuracy.

Validates Federal Employer Identification Number (FEIN) Format

This check verifies that the 'Federal employer identification number (FEIN)' for both the employer and insurance carrier is entered in the correct XX-XXXXXXX format. The FEIN is a unique identifier for business entities, and correct formatting is essential for database lookups and regulatory reporting. An incorrectly formatted FEIN could lead to misidentification of the employer or carrier, delaying the reimbursement process.

Verifies Standard Email Address Format

This validation ensures that the email address fields for the employer and insurance carrier follow the standard '[email protected]' syntax. A valid email is critical for all electronic communication regarding the status of the reimbursement request. If the format is incorrect, automated notifications and manual communications may fail, leaving the submitter uninformed about their request.

Validates First Day of Absence is After Injury

This logical check confirms that the 'First day employee was absent from work' is on or after the 'Date of injury'. An employee cannot be absent from work due to an injury before the injury occurred. This validation prevents chronological errors that would question the validity of the entire claim and cause processing delays.

Validates First Payment Date is After Absence

This check ensures the 'Date of first payment' is on or after the 'First day employee was absent from work'. Voluntary payments are made to cover lost wages or expenses incurred after the employee stops working. A payment date preceding the absence date is illogical and would trigger a validation failure, requiring the user to correct the dates.

And 6 more checks
  • Ensures Payment Period 'To' Date is After 'From' Date
  • Confirms Payment Amount is a Positive Value
  • Requires At Least One Payment Type Selection
  • Validates Signature Date is Logical and Present
  • Correlates Payment Period with Number of Weeks Paid
  • Ensures All Required Employer Information is Provided

Let AI fill out your DWC002

No typing. Every field filled in seconds, checked, ready to sign.

7 days free, then $19.99/month · Cancel anytime

How to Fill Out DWC002 Online for Free in 2026

What the AI walks you through.

  1. Navigate to Instafill.ai and upload or select the DWC002 form.
  2. Use the AI assistant to fill in Part 1 with the injured employee's information, including their name, address, SSN (last four digits), and date of injury.
  3. Complete Part 2 by providing your employer details, such as name, FEIN, and information about the voluntary payment made.
  4. Enter the insurance carrier's information in Part 3, including their name, address, and FEIN.
  5. Review all the information entered by the AI for accuracy and completeness across all sections.
  6. Proceed to Part 4 to certify the form with your digital signature and the current date.
  7. Download the completed DWC002 and send copies to the Texas Department of Insurance, Division of Workers’ Compensation (DWC) and the insurance carrier as instructed.

Common Mistakes in Completing DWC002

The ones the AI is built to catch.

Missing DWC or Insurance Carrier Claim Numbers
These numbers are often overlooked because they are located at the top of the form, separate from the main numbered sections. Submitting the form without these critical identifiers makes it impossible for the DWC and insurance carrier to link the reimbursement request to the correct case, leading to immediate rejection or significant processing delays. Before filling out the form, confirm both claim numbers with the insurance carrier to ensure the document can be processed correctly.
Inconsistent or Incorrect Date Formatting
The form specifies an 'mm/dd/yyyy' format for all date fields, but people often use other formats like 'm/d/yy' or 'dd/mm/yyyy' out of habit. This inconsistency can cause data entry errors in automated systems, leading to incorrect calculations for deadlines and payment periods, which delays reimbursement. Always double-check that all dates are entered in the required two-digit month, two-digit day, and four-digit year format to prevent processing issues.
Confusing Employer FEIN with Insurance Carrier FEIN
The form requests a Federal Employer Identification Number (FEIN) for both the employer (Part 2) and the insurance carrier (Part 3), and it's easy to enter the same number in both fields by mistake. This error incorrectly identifies the parties involved, causing the insurance carrier's system to reject the submission and delaying reimbursement. To avoid this, carefully read the section headers and verify you are entering the unique nine-digit FEIN for the correct entity in each respective field.
Forgetting to Sign and Date the Certification
The signature and date in Part 4 are a legal certification of the form's accuracy, but this final step is frequently forgotten in the rush to submit. An unsigned form is considered invalid and will be rejected, which delays the entire reimbursement process and can cause the employer to miss the strict 7-day filing deadline. To prevent this, make a final check for a valid signature and date your absolute last step before faxing or mailing the form.
Failing to Complete Information on All Pages
The footer on each of the three pages requires the employee's name and DWC claim number, but filers often complete it on the first page and neglect the others. If the pages become separated during mail or fax processing, the un-labeled pages cannot be associated with the claim, rendering the submission incomplete. Ensure these details are filled out on every single page to guarantee the integrity of your submission, even if pages are separated.
Miscalculating Payment Periods and Amounts
Mistakes are common when correlating the 'Amount of payment' (Field 14), 'Number of weeks paid' (Field 15), and the 'Payment period from/to' dates (Field 16). Manual calculation errors or misunderstanding how to define a 'week' can lead to discrepancies that cause the insurance carrier to dispute the reimbursement amount. Carefully cross-reference these fields to ensure the payment amount accurately reflects the compensation rate for the exact period specified, preventing disputes and resubmissions.
Missing the 7-Day Filing Deadline
The FAQ clearly states the form must be filed within seven days of the first payment, a deadline many employers are unaware of or fail to meet. The consequence is severe and explicit: failure to file on time waives the employer's right to reimbursement for any voluntary payments, resulting in a direct financial loss. To avoid this, be aware of the deadline triggered by the 'Date of first payment' and submit the form immediately.
Using an Abbreviated or Incorrect Employee Name
Filers may use a nickname (e.g., 'Bill' for 'William') or omit a middle name, which seems minor but can cause significant issues. If the name on the form does not exactly match the legal name in the DWC or insurance carrier's system, it can cause a record-matching failure. This delays claim linkage and reimbursement, so always use the employee's full legal name as it appears on official employment records.
Confusing Insurance Carrier Address with Claims Office Address
Part 3 asks for both the insurance carrier's main address (Field 19) and its claims office address (Field 24), which are often different, but filers may only know the corporate address. Using the general corporate address instead of the specific claims department address can cause correspondence to be misrouted, leading to significant delays. Always verify the direct address for the claims processing office to ensure your form and any follow-up communication are handled efficiently.
Incorrectly Checking the Payment Purpose Box
In Field 17, filers may be confused about whether a payment 'Begins compensation,' 'Supplements income,' or 'Covers medical expenses,' and check the wrong box. This misclassifies the payment, which can complicate how the insurance carrier processes the reimbursement and coordinates benefits, potentially leading to disputes. Clearly identify if the payment is for lost wages or a medical bill and check the corresponding box to ensure accurate processing.
Submitting an Illegible or Poorly Scanned Form
This form is often submitted as a flat PDF that must be printed, filled by hand, and then scanned or faxed, which can result in poor legibility. If numbers, names, or dates are unreadable, the processing office cannot enter the data correctly, leading to rejection and requiring the employer to start over. To prevent this, write clearly in block letters or use a tool like Instafill.ai, which can convert non-fillable PDFs into fillable versions for clean, typed entries.

Frequently Asked Questions About DWC002

 

Is it really free for 7 days?
Yes. You pay $0 today. Cancel before Nov 7 and you are never charged. Keep it, and it is $19.99 a month for 5 fills of your DWC002.
Can I fill other forms too?
This plan is for your DWC002: your own AI agent fills it as often as 5 times a month. To fill other forms and upload your own, choose a Professional plan from your account.
How do I cancel?
From your account, in two clicks, any time. No email, no call.
How does the AI fill out DWC002?
You answer a few questions in plain words, or upload a document you already have. The AI reads what you give it and puts each answer into the right field of DWC002, on every page, in seconds. It checks the answers against the form's own rules, and you review and change anything before you download, print or sign.
What happens to my information?
It is encrypted in transit and at rest, and it is never used to train AI.
How complex is DWC002 to fill out?
DWC002 has a Form Complexity Index of 39 out of 100, in the basic tier: 30 fillable fields across 2 pages. Instafill.ai's AI fills it in under a minute, with every field there for you to review before you download.
What is the purpose of the DWC002 form?
This form is used by an employer to request reimbursement from their insurance carrier for voluntary payments, such as income supplements or medical expenses, made to an injured employee.
Who needs to fill out the Employer’s Report for Reimbursement of Voluntary Payment?
An employer who has made voluntary payments directly to an injured employee and wishes to be reimbursed by their workers' compensation insurance carrier should complete and submit this form.
Where do I send the completed DWC002 form?
You must send a copy of the completed form to both the Texas Department of Insurance, Division of Workers’ Compensation (DWC) and your insurance carrier. The form provides specific fax and mail details for the DWC.
Is there a deadline for submitting this form?
Yes, you must send this form to the DWC and your insurance carrier within seven days after the date you made the first voluntary payment to the employee. Missing this deadline can waive your right to reimbursement.
How long does it take to get reimbursed after submitting the form?
Your insurance carrier should reimburse you within seven days after receiving your completed DWC002 form. The carrier must also notify the DWC of the reimbursement.
What should I do if my insurance carrier refuses to reimburse me?
If a dispute arises and your insurance carrier refuses to provide reimbursement, you have the right to file a subclaim with the DWC to resolve the issue.
What if I don't know the DWC claim number or insurance carrier claim number?
The form states you should complete these fields 'if known.' If you do not have these numbers, fill out the rest of the form completely to avoid delays and submit it on time.
What other documents do I need to file along with this form?
You must also ensure you have timely filed the DWC Form-001, Employer’s First Report of Injury or Illness. Failure to file the DWC Form-001 on time will also waive your right to reimbursement for voluntary payments.
Can I use an AI tool to help me fill out the DWC002 form?
Yes, services like Instafill.ai use AI to accurately auto-fill form fields from your saved information, which can save you significant time and help reduce errors.
How can I fill out the DWC002 form online?
You can use a service like Instafill.ai to upload the form, and its AI will help you fill in the required fields quickly and accurately online. You can then download, print, or share the completed document.
The PDF version of this form I have is not fillable. What can I do?
If you have a non-fillable PDF, you can upload it to a platform like Instafill.ai. The service can convert flat PDFs into interactive, fillable forms that you can easily complete on your computer.
What is a Federal Employer Identification Number (FEIN) and why is it needed?
The FEIN is a unique nine-digit number assigned by the IRS to business entities. It is required in Parts 2 and 3 to correctly identify the employer and the insurance carrier involved in the claim.
In Part 2, what is the difference between 'Date of first payment' and 'Payment period from'?
'Date of first payment' is the specific date you issued the first payment. 'Payment period from' is the start date of the time period that the payment is intended to cover, which may be different.
Encrypted in transit and at restNever used to train AIDelete your forms any time

Get your DWC002 filled out by AI

$0 today. Cancel before Nov 7 and you pay nothing.

Other forms like this one

workers compensation forms: State of New Mexico Workers’ Compensation Administration — Workers' Compensation Complaint (Rev. 8/22) (11.4.4.9 NMAC), DWC Form-001, Employer’s first report of injury or illness, DWC001S, Employer’s first report of injury or illness, Form BWC-1141, Request for Medical Information, ACORD 130 CA, California Workers Compensation Application, Form CA-17, Duty Status Report

employer forms: Form 940, Employer’s Annual FUTA Tax Return, Form 8027, Employer’s Annual Information Return, Form DE 1, Commercial Employer Account Registration, Form 8994, Employer Credit for Paid Family and Medical Leave, Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, Form 941, Employer’s Quarterly Federal Tax Return, Form I-129CWR, Semiannual Report for CW-1 Employers, Form 941-X (Rev. April 2023), Adjusted Employer’s QUARTERLY Federal Tax Return or Claim for Refund, C139 – Employer’s Information Questionnaire (WCB Alberta), Form SS-4 (Rev. December 2025), Application for Employer Identification Number, City of Carlinville Application for Employment (An Equal Opportunity Employer), Form 941, Employer's QUARTERLY Federal Tax Return (Rev. March 2025), Easy Transfer Form: Moving Funds to an Employer-Sponsored Retirement Plan at TIAA, Form F10462, Moving Funds to an Employer-Sponsored Retirement Plan at TIAA, Moving Funds to an Employer-Sponsored Retirement Plan at TIAA, Form F10794, Cash Withdrawal or Rollover Transfer Payout Annuity for Private Employer Plans, DWC001S, Employer’s first report of injury or illness, DWC Form-001, Employer’s first report of injury or illness, The E-Verify Memorandum of Understanding for Employers, SIMPLE Retirement Account (SRA) Program Employer Notice and Salary-Reduction Agreement

insurance claim forms: Continental American Insurance Company (CAIC) / Aflac Group Critical Illness Claim Form (with Attending Physician’s Statement, HIPAA Authorization to Obtain Information, and Electronic Funds Transaction Authorization), Assurity Life Insurance Company Disability Claim Form — Attending Physician’s Statement, VA Form 29-357, Claim for Disability Insurance Benefits (Government Life Insurance), CMS-1500 (02-12), Health Insurance Claim Form (NUCC Approved) (OMB 0938-1197), Standard Health Insurance Claim Form - Part B, Form BWC-1141, Request for Medical Information, Lincoln Financial Group Requesting a distribution, Bajaj Allianz Overseas Travel Insurance Claim Form, CMS-1500 Health Insurance Claim Form (OMB-0938-0999), ACORD 160, Property Loss Notice

payment forms: Form 5405, Repayment of First-Time Homebuyer Credit, Form 1127, Application for Extension of Time for Payment of Tax Due to Undue Hardship, Form 1099-G, Certain Government Payments, Form 1099-K, Payment Card and Third Party Network Transactions, Form 1099-Q, Payments From Qualified Education Programs, Form SSA-8, Application for Lump-Sum Death Payment, Form 1845-0163, Borrower Defense to Repayment Application, application-and-contract-for-electric-facilities-w, Carer Payment and Carer Allowance – Medical Report (SA431) for a child under 16 years, Income-Driven Repayment (IDR) Plan Request (PAYE, IBR, and ICR) — William D. Ford Federal Direct Loan (Direct Loan) Program and Federal Family Education Loan (FFEL) Programs (OMB No. 1845-0102), Fidelity NetBenefits Distribution - Recurring Payments, Electronic Dividend and Interest Payment Authorization Form, Vanguard Super Apply for a financial hardship payment, Special Tax Notice Regarding Plan Payments, Empower Loan Payment Change Request Form, Empower Retirement Payment Request Form, Empower 401(k) Loan Prepayment Request Form, Special Tax Notice Regarding Plan Payments, Transamerica Automatic Payment Authorization, Excess Withdrawal Request and Form W-4R, Withholding Certificate for Nonperiodic Payments and Eligible Rollover Distributions

DWC forms: DWC Form-001, Employer’s first report of injury or illness, DWC001S, Employer’s first report of injury or illness, Form DFS-F2-DWC-1a, Wage Statement, DWC Form RFA, Request for Authorization

7 days free, then $19.99/month · Cancel anytime