Form DWC-11-IC Revised 2/06.
The purpose of this DWC-11-IC form is to clarify the relationship between a contractor and the business hiring the contractor. Submitting this form means that the contractor is not an employee of the hiring business for workers' compensation purposes. The contractor is responsible for his own workers' compensation insurance coverage. The hiring business is not responsible to provide workers' compensation coverage for the independent contractor. This is the pdf version. An excel version is also available.