Texas DWC

You should report your injury to your supervisor or management as soon as you are aware of the injury. Timely reporting is important.

You have the right to choose your treating doctor. You do not have to be treated by the company doctor. If your claim is a network claim, then the selection of doctor must be from that WC Plan. Contact Ms. Santiago for assistance. The Emergency Room physician is not considered your treating doctor.

Get the name/phone number of any person that witnessed the injury/accident.

You must file a Notice of Injury/Claim (DWCC 41) with TDI within 1 year from your date of Injury.

You are entitled to receive Temporary Income Benefits if you are unable to work.

You may receive Impairment Income Benefits if you are permanently injured.

The Adjuster must request an order from TDI before you are required to see a doctor of their choice.

Under Law, your employer can not terminate you for filing a workers’ compensation claim.

Federal Workers´ Compesation Forms

BENEFIT DISPUTE AGREEMENT - dwc24

Claim for Workers’ Compensation Death Benefits - dwc042benclm

DWC 3 Multiple employers Wage statement

DWC Form-025, Benefit Dispute Settlement - dwc25

DWC Form-032, Request for designated doctor examination - dwc032desdoc

DWC Form-038, Application for lifetime income benefits (LIBs) - dwc038libs

DWC Form-039, First responder’s annual certification for lifetime income benefits

DWC Form-045, Request to Schedule, Reschedule, or Cancel a Benefit Review Conference BRC

DWC Form-046, Request to accelerate impairment income benefits - dwc046

DWC Form-047, Request to Advance Benefits - dwc047adv

DWC Form-051, Request for a lump sum payment of impairment income benefits (IIBs) - dwc051iibs

DWC Form-052, Supplemental income benefits (SIBs) application - dwc052sibs