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Name
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File Type
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Programs
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Most Viewed
|
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Alliance Employee Acknowledgement of Requirements
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PDF
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Workers' Compensation
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Alliance Employee Acknowledgement of Requirements in Spanish
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PDF
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Workers' Compensation
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Alliance Instructions for Members
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PDF
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Workers' Compensation
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Alliance Notice for Posting in English
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PDF
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Workers' Compensation
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Alliance Notice for Posting in Spanish
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PDF
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Workers' Compensation
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Alliance Notice of Alliance Requirements
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PDF
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Workers' Compensation
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Alliance Notice of Alliance Requirements in Spanish
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PDF
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Workers' Compensation
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Alliance Treating Doctor Change Request
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PDF
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Workers' Compensation
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Alliance Treatments Requiring Preauthorization
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PDF
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Workers' Compensation
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Application for Fund Coverage
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PDF
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General
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Blood Pathogen Control Plan―Compliance Checklist
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PDF
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Workers' Compensation
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Blood Pathogen Control Plan
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PDF
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Workers' Compensation
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|
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Bona Fide Offer of Employment
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DOC
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Workers' Compensation
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Bona Fide Offer of Employment (Spanish)
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DOC
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Workers' Compensation
|
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DWC 1, Employer's First Report of Injury (FROI) (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 156, Prospective Employment Authorization and Certification Form (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 2, Employer's Report for Reimbursement of Voluntary Payment (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 3, Employer's Wage Statement (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 3, Employer's Wage Statement (App)
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HTML
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Workers' Compensation
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DWC 32, Request for Designated Doctor Examination (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 3ME, Employee's Multiple Employment Wage Statement (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 3MES, Declaracíon de Salario de Múltiples Trabajos de Empleado (tdi.texas.gov) (Spanish)
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PDF
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Workers' Compensation
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DWC 3SD, Employer's Wage Statement for School Districts (App)
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HTML
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Workers' Compensation
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DWC 3SD, Employer's Wage Statement for School Districts (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 3SDS, Declaracíon de Salario Para Escuelas de Distrito (tdi.texas.gov)(Spanish)
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PDF
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Workers' Compensation
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DWC 4, Employer's Contest of Compensability (tdi.texas.gov)
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PDF
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Workers' Compensation
|
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DWC 41, Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease (tdi.texas.gov)
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PDF
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Workers' Compensation
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|
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DWC 45, Request to Schedule, Reschedule, or Cancel a Benefit Review Conference (BRC) (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 47, Employee's Request for Advance of Benefits (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 48, Request for Travel Reimbursement (tdi.texas.gov)(English and Spanish)
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PDF
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Workers' Compensation
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DWC 52, Application for Supplemental Income Benefits (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 6, Supplemental Report of Injury (App)
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HTML
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Workers' Compensation
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DWC 6, Supplemental Report of Injury (tdi.texas.gov)
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PDF
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Workers' Compensation
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|
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DWC 68, Designated Doctor Examination Data Report (tdi.texas.gov)
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PDF
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Workers' Compensation
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DWC 69, Report of Medical Evaluation
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PDF
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Workers' Compensation
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DWC 73, Work Status Report (tdi.texas.gov)
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PDF
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Workers' Compensation
|
|
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DWC 74, Description of Injured Employee's Employment (tdi.texas.gov)
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PDF
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Workers' Compensation
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|
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DWC Notice 6, Notice to Employees Concerning Workers' Compensation in Texas (tdi.texas.gov)(Spanish)
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PDF
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Workers' Compensation
|
|
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DWC Notice 6, Notice to Employees Concerning Workers' Compensation in Texas (tdi.tx.gov)
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PDF
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Workers' Compensation
|
|
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DWC Notice 8, Required Workers' Compensation Coverage (building or construction projects for governmental entities) (tdi.texas.gov)
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PDF
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Workers' Compensation
|
|
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DWC Notice 9, Notice Regarding Certain Work-Related Communicable Diseases and Eligibility for Workers' Compensation Benefits (tdi.texas.gov)
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PDF
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Workers' Compensation
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|
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Electronic Fund Transfer Form
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PDF
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General
|
|
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FAQs: Injured employees
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HTML
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Workers' Compensation
|
|
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First Fill Prescription Card
|
PDF
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Workers' Compensation
|
|
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First Report of Injury (FROI)
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HTML
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Workers' Compensation
|
|
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GASB Statement 10
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HTML
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General
|
|
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Leave Election Non-Offset Form
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DOC
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Workers' Compensation
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|
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Leave Election Non-Offset Form in Spanish
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DOC
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Workers' Compensation
|
|
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Leave Election Offset Form
|
DOC
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Workers' Compensation
|
|
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Leave Election Offset Form in Spanish
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DOC
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Workers' Compensation
|
|
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Notice to Political Subdivision Employees of Coverage in English
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PDF
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Workers' Compensation
|
|
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Notice to Political Subdivision Employees of Coverage in Spanish
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PDF
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Workers' Compensation
|
|
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Notice: Office of Injured Employee Counsel First Responder(Spanish)
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PDF
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Workers' Compensation
|
|
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Notice: Office of Injured Employee Counsel First Responder (English)
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PDF
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Workers' Compensation
|
|
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Post-Hurricane Recovery Checklist
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PDF
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Auto, Liability, Property, Workers' Compensation, Loss Prevention, Emergency Management, Privacy and Information Security
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Posting: Office of Injured Employee Counsel Ombudsman Program(Spanish)
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PDF
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Workers' Compensation
|
|
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Posting: Office of Injured Employee Counsel Ombudsman Program (English)
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PDF
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Workers' Compensation
|
|
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Preauthorization Request for Healthcare Services
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PDF
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Workers' Compensation
|
|
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Preauthorization Request for Prescription Drugs
|
PDF
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Workers' Compensation
|
|
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Program Coordinator Change Form
|
PDF
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General
|
|
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Return-to-Work Manual
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HTML
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Workers' Compensation
|
|
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Verification of Employment for a Reported Injury or Illness
|
DOC
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Workers' Compensation
|
|
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WC002 Employers Report for Reimbursement of Voluntary Payment
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PDF
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Workers' Compensation
|
|
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When to File a COVID-19 Claim
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PDF
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Workers' Compensation
|
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