Workers' Compensation Downloads

Application for Coverage from the TASB Risk Management Fund

 

Form File Format Language

*New Employee Notice of Coverage for Political Subdivisions

*Please note that per Sec. 504.018(b), employees of a political subdivision are conclusively considered to have accepted the compensation provisions instead of common law or statutory liability or cause of action, if any, for injuries received in the course of employment or death resulting from injuries received in the course of employment. Therefore, Rule 110.101(s)(5), advising employers to inform new employees of their rights to retain their common law right of action does not apply to political subdivisions. This "New Employee Notice" is written specifically for political subdivisions, with the correct information.

Employer Required DWC Postings

DWC Notice 6, Notice to Employees Concerning Workers' Compensation in Texas PDF English
DWC Notice 6, Notice to Employees Concerning Workers' Compensation in Texas PDF Spanish
DWC Notice 8, Required Workers' Compensation Coverage (building or construction projects for governmental entities) PDF English
DWC Notice 9, Notice Regarding Certain Work-Related Communicable Disease and Eligibility for Workers' Compensation Benefits PDF English
Office of Injured Employee Counsel (OIEC) Ombudsman Program Notice PDF English/
Spanish

Sample Documents and DWC Forms

Medical Release of Information DOC English
Forma Médica del Lanzamiento DOC Spanish
Network Acknowledgement Form DOC English
Notice of Injured Employee Rights and Responsibilities in the Texas WC System PDF English
Spanish
Chinese
Vietnamese
Korean
DWC 1, Employer's First Report of Injury PDF English
DWC 2, Employer's Report for Reimbursement of Voluntary Payment PDF English
DWC 3, Employer's Wage Statement PDF English
DWC 3S, Declaracíon de Salario del Empleador PDF Spanish
DWC 3ME, Employee's Multiple Employment Wage Statement PDF English
DWC 3MES, Declaracíon de Salario de Múltiples Trabajos de Empleado PDF Spanish
DWC 3SD, Employer's Wage Statement for School Districts PDF English
DWC 3SDS, Declaracíon de Salario Para Escuelas de Distrito PDF Spanish
DWC 4, Employer's Contest of Compensability PDF English
DWC 6, Supplemental Report of Injury PDF English
DWC 47, Employee's Request for Advance of Benefits PDF English
DWC 48, Request for Travel Reimbursement/Solicitud de Reembolso PDF English/
Spanish
DWC 53, Employee Request to Change Treating Doctor PDF English
DWC 73, Work Status Report PDF English
DWC 74, Description of Injured Employee's Employment PDF English

 
 
 
 
WC Pool Bid Specs.doc 
147 KB DOC

WC ASO Bid Specs.doc 
218 KB DOC

Member Application 
563 KB PDF

New Employee Notice 
35 KB DOC