|
Name
|
File Type
|
Programs
|
Most Viewed
|
|
Alliance Change of Treating Doctor
|
PDF
|
Workers' Compensation
|
|
|
Application for Coverage
|
PDF
|
General
|
|
|
Bid Specifications Sample: Workers' Compensation ASO
|
DOC
|
Workers' Compensation
|
|
|
Bid Specifications Sample: Workers' Compensation ASO
|
PDF
|
Workers' Compensation
|
|
|
Bid Specifications Sample: Workers' Compensation Pool
|
PDF
|
Workers' Compensation
|
|
Blood Pathogen Control Plan―Compliance Checklist
|
PDF
|
Workers' Compensation
|
|
|
Blood Pathogen Control Plan
|
PDF
|
Workers' Compensation
|
|
|
Bona Fide Offer of Employment
|
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 (App)
|
HTML
|
Workers' Compensation
|
|
|
DWC 32, Request for Designated Doctor Examination (tdi.texas.gov)
|
PDF
|
Workers' Compensation
|
|
|
DWC 33, Carrier's Request for Reduction of Income Benefits Due to Contribution (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 (App)
|
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 53, Employee Request to Change Treating Doctor (tdi.texas.gov)
|
PDF
|
Workers' Compensation
|
|
|
DWC 6, Supplemental Report of Injury (App)
|
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
|
|
|
DWC Safety Violations Hotline (tdi.texas.gov)(Spanish)
|
HTML
|
Workers' Compensation
|
|
|
Electronic Fund Transfer Form
|
PDF
|
General
|
|
|
Employee Acknowledgement of Alliance Requirements
|
DOC
|
Workers' Compensation
|
|
|
Employee Acknowledgement of Alliance Requirements(Spanish)
|
DOC
|
Workers' Compensation
|
|
|
Employee Notice of Alliance Requirements
|
DOC
|
Workers' Compensation
|
|
|
Employee Safety Handbook (Community Colleges): Administrative/Instructional
|
HTML
|
Workers' Compensation
|
|
|
Employee Safety Handbook (Community Colleges): Operations Support
|
HTML
|
Workers' Compensation
|
|
|
Employee Safety Handbook (Community Colleges): Operations Support(Spanish)
|
HTML
|
Workers' Compensation
|
|
|
Employee Safety Handbook: Administrative/Instructional
|
HTML
|
Workers' Compensation
|
|
|
Employee Safety Handbook: Custodial(Spanish)
|
HTML
|
Workers' Compensation
|
|
|
Employee Safety Handbook: Custodial
|
HTML
|
Workers' Compensation
|
|
|
Employee Safety Handbook: Food Service(Spanish)
|
HTML
|
Workers' Compensation
|
|
|
Employee Safety Handbook: Food Service
|
HTML
|
Workers' Compensation
|
|
|
Employee Safety Handbook: Maintenance (Spanish)
|
HTML
|
Workers' Compensation
|
|
|
Employee Safety Handbook: Maintenance
|
HTML
|
Workers' Compensation
|
|
|
Employee Safety Handbook: Transportation(Spanish)
|
HTML
|
Auto, Workers' Compensation
|
|
|
Employee Safety Handbook: Transportation
|
HTML
|
Auto, Workers' Compensation
|
|
|
FAQs: Injured employees
|
HTML
|
Workers' Compensation
|
|
|
First Report of Injury (FROI) (App)
|
HTML
|
Workers' Compensation
|
|
|
Forma Médica del Lanzamiento(Spanish)
|
DOC
|
Workers' Compensation
|
|
|
GASB Statement 10
|
HTML
|
General
|
|
|
How to Save the First Report of Injury FROI(English)
|
PDF
|
Workers' Compensation
|
|
|
Instructions for Alliance Members
|
PDF
|
Workers' Compensation
|
|
|
Leave Election Form (No Offset)
|
DOC
|
Workers' Compensation
|
|
|
Leave Election Form (No Offset)(Spanish)
|
DOC
|
Workers' Compensation
|
|
|
Leave Election Form (Offset)(Spanish)
|
DOC
|
Workers' Compensation
|
|
|
Leave Election Form (Offset)
|
DOC
|
Workers' Compensation
|
|
|
Loss Prevention Manual
|
HTML
|
Workers' Compensation
|
|
|
Loss Prevention Online Resources
|
HTML
|
Workers' Compensation
|
|
|
Loss Prevention Safety Kits
|
HTML
|
Workers' Compensation
|
|
|
Medical Release of Information
|
DOC
|
Workers' Compensation
|
|
|
New Employee Notice of Coverage for Political Subdivisions(English and Spanish)
|
PDF
|
Workers' Compensation
|
|
|
Notice of Injured Employee Rights and Responsibilities in the Texas Workers' Compensation System
|
HTML
|
Workers' Compensation
|
|
|
Office of Injured Employee Counsel Ombudsman Program Notice (oeic.state.tx.us)
|
HTML
|
Workers' Compensation
|
|
|
Posting of Alliance Requirements for Work-Related Injuries
|
PDF
|
Workers' Compensation
|
|
|
Post-Injury Earnings Report Instructions
|
HTML
|
Workers' Compensation
|
|
|
Preauthorization Request Form: Healthcare Services
|
PDF
|
Workers' Compensation
|
|
|
Program Coordinator Change Form
|
PDF
|
General
|
|
|
Return-to-Work Manual
|
HTML
|
Workers' Compensation
|
|
|
Safety Hot Topic: Flu Prevention & Mitigation
|
HTML
|
General
|
|
|
Safety Hot Topic: Inclement Winter Weather
|
HTML
|
General
|
|
|
Safety Hot Topic: New Year Campus Safety Checklist
|
HTML
|
General
|
|
|
Safety Hot Topic: Tricks, Treats, and Safety Tips
|
HTML
|
General
|
|
|
Step-by-Step through a Workers' Compensation Claim
|
PDF
|
Workers' Compensation
|
|
|
Treatments Requiring Preauthorization (Alliance Providers)
|
PDF
|
Workers' Compensation
|
|
|
Treatments Requiring Preauthorization (Non-Alliance Providers)
|
PDF
|
Workers' Compensation
|
|
|
Verification of Employment for a Reported Injury or Illness
|
PDF
|
Workers' Compensation
|
|
|
WC Coverage Verification Form
|
DOC
|
Workers' Compensation
|
|
|
WC002 Employers Report for Reimbursement of Voluntary Payment
|
PDF
|
Workers' Compensation
|
|
|
Workers' Compensation Manual (downloads)
|
HTML
|
Workers' Compensation
|
|
|
Workers’ Compensation Manual
|
HTML
|
Workers' Compensation
|
|