DWC003ME - Employee's Multiple Employment Wage Statement

What this form is

The DWC003ME, Employee's Multiple Employment Wage Statement, reports the wages you earned from an employer other than the one where you were injured. The insurance carrier, called the carrier, calculates your average weekly wage, called your AWW, from the wages reported on your claim. Without this form, that calculation includes only the job where you got hurt. If you held two jobs and your injury keeps you from working both, benefits based on one paycheck replace only part of what you actually lost. The DWC003ME is how the second paycheck gets counted. AWW for Workers With Multiple Employers explains how the combined wage is calculated and what it does to your weekly check.

Who files it, and when

Here the usual roles reverse. The employer where you were injured files its own wage statement, form DWC003, without your involvement. The DWC003ME is different: in practice, it gets filed because you make it happen. You obtain the form, you ask your other employer to complete the wage section, and you see that it is submitted. Your other employer has no duty to volunteer it, the claim employer does not know your other jobs exist, and the carrier has no reason to ask.

The form states no filing deadline. Treat that as a reason to move quickly, not slowly. Until the form is filed, every check is calculated from one job's wages, and getting the difference corrected afterward is slower than getting the wage counted from the start.

What the form reports, and what to attach

The wage section covers the same window as the regular wage statement: the 13 weeks before your injury, or 14 weeks if that employer paid you every two weeks, or three months if monthly. It reports gross wages, meaning pay before taxes and deductions.

One limit matters and is easy to miss: only wages reported for federal taxes count. A weekend job paid in cash, with nothing reported to the IRS, cannot be added through this form. If some of your second-job pay was reported and some was not, the reported portion still counts.

Keep your own proof alongside the form: pay stubs, W-2s, or bank deposits from the second job. If the other employer is slow, has closed, or refuses to cooperate, those records are what allow the wages to be established another way, so do not wait on the employer's signature to start gathering them.

Where to send it

Send the completed form to both the carrier and the Division of Workers' Compensation, called the DWC. This differs from the regular DWC003, which goes to the carrier. Keep a copy of the completed form and proof of when and where you sent it.

The trap

The trap on this form is not a box or a deadline. It is silence. No one in the system asks an injured worker whether they held other jobs. The claim proceeds, the checks arrive, and the worker assumes the amount reflects everything they earned. It reflects one job. If you worked a second job on the date you were injured, raise it: tell the adjuster in writing, tell your attorney if you have one, and start the DWC003ME. Workers who never raise the second job simply receive smaller checks for the life of the claim.