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