What Is the TX Certificate of Workers' Compensation Form C‑105?
The Certificate of Workers' Compensation, commonly known as Form C‑105, is the official document that Texas employers file with the Texas Department of Insurance (TDI) to prove they carry valid workers' compensation coverage. The form lists the insurer, policy number, effective dates, and the number of employees covered.
- What Is the TX Certificate of Workers' Compensation Form C‑105?
- When Must You File Form C‑105?
- Step‑by‑Step: How to Complete Form C‑105
- 1. Gather Basic Information
- 2. Fill Out the Form
- 3. Sign and Date
- 4. Submit to TDI
- Common Mistakes to Avoid
- Key Deadlines and Penalties
- Frequently Asked Questions
- Do I need to file Form C‑105 if I have no employees?
- Can I file Form C‑105 online?
- What happens if I file late?
- How to Check Your Filing Status
- Summary
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When Must You File Form C‑105?
All Texas employers with one or more employees are required to file Form C‑105 annually, no later than the last day of the calendar year in which the coverage was effective. Late filings can trigger penalties and may result in loss of coverage.
Step‑by‑Step: How to Complete Form C‑105
1. Gather Basic Information
- Employer name and address
- Employer Identification Number (EIN)
- Insurance carrier name and address
- Policy number and effective dates
- Number of employees covered
2. Fill Out the Form
Use a pen or type directly into the PDF. Ensure all fields are legible and accurate. Pay particular attention to the policy effective dates; they must match the dates on the insurance policy.
3. Sign and Date
The employer's authorized representative must sign and date the form. If the form is filed electronically, a digital signature is acceptable.
4. Submit to TDI
Submit the completed form via the TDI online portal, by mail, or in person at a TDI office. Keep a copy for your records.
Common Mistakes to Avoid
- Submitting an outdated policy number
- Using incorrect employee counts
- Missing the signature or date
- Failing to file by the annual deadline
Key Deadlines and Penalties
| Event | Deadline | Penalty |
|---|---|---|
| Annual filing of Form C‑105 | December 31 of the coverage year | Up to $200 per employee for non‑compliance |
| Late filing after 30 days | Additional $100 per employee | Risk of coverage suspension |
Frequently Asked Questions
Do I need to file Form C‑105 if I have no employees?
No. Employers with zero employees are not required to file.
Can I file Form C‑105 online?
Yes. TDI offers an online filing system that accepts electronic submissions and digital signatures.
What happens if I file late?
Late filings may result in penalties and can jeopardize your workers' compensation coverage, leaving your business vulnerable to liability.
How to Check Your Filing Status
Log into the TDI online portal and navigate to the "Workers' Compensation" section. You can view your most recent filing, download a copy, and confirm that your records are current.
Summary
Form C‑105 is a mandatory, annual filing that verifies your Texas business's workers' compensation coverage. By collecting the right information, completing the form accurately, and submitting it on time, you protect your employees and avoid costly penalties.