PLN04
This notice must be used to report to the injured employee/representative the approval of LIBs.
DWC006
The Texas Department of Insurance, Division of Workers’ Compensation (DWC) requires either the employer or the injured employee to report to the insurance carrier all return-to-work activity and post-injury change of earnings. This allows the insurance carrier to adjust the weekly amount of temporary income benefits (TIBs) paid to an injured employee to match the changes in weekly earnings after the injury.
DWC002
Send a copy of this form to the Texas Department of Insurance, Division of Workers’ Compensation (DWC) and the insurance carrier. You can fax or mail the completed form to DWC or drop the form off at a DWC field office.
DWC001
Send this form to your workers’ compensation insurance carrier and to the injured employee or the injured employee’s representative. Do not send this form to the Texas Department of Insurance, Division of Workers’ Compensation (DWC), unless DWC specifically requests it.
DWC020SI
You must file DWC Form-020SI, Governmental entity coverage information:
Within 10 days after the effective date of self-insurance coverage or claim administration agreement and each year after that, no later than 10 days after the anniversary date of coverage or agreement;
Within 30 days after the date the political subdivision begins to provide medical benefits in accordance with Texas Labor Code Section 504.053(b)(2);
Within 30 days of any change in the manner the political subdivision provides medical benefits;
On joining, leaving, or changing pools or groups; and
On buying a workers’ compensation insurance policy.
DWC052
For each week during the qualifying period, you must:
1)show active participation in a vocational rehabilitation program provided by the Texas Workforce Commission(TWC) or a private vocational rehabilitation provider;
2)show active participation in work search efforts conducted through TWC; or
3)show you were actively looking for a job by attaching job applications or other documents showing you have applied or asked for a job.
DWC052S
Para el primer trimestre, envíe este formulario y cualquier documentación pertinente al Departamento de Segurosde Texas, División de Compensación para Trabajadores (Division of Workers’ Compensation -DWC, por su nombre ysiglas en inglés) antes de la fecha límite de presentación que aparece en la carta de notificación de SIBs.
DWC105
Insurance companies undergoing inspections by the Texas Department of Insurance, Division of Workers’ Compensation (DWC) required by 28 Texas Administrative Code Section 166.5 (Inspections of Adequacy of Accident Prevention Facilities and Services) must file the DWC Form-105. Insurance companies are responsible for timely and accurately filing the DWC Form-105.
DWC109
An insurance company writing workers’ compensation insurance in Texas must file the DWC Form-109 with DWC as an annual report of its accident prevention services. Insurance companies must file the DWC Form-109 accurately and on time. A DWC Form-109 is considered filed with DWC only when it contains all required information.
DWC105
Insurance companies undergoing inspections by the Texas Department of Insurance, Division of Workers’ Compensation (DWC) required by 28 Texas Administrative Code Section 166.5 (Inspections of Adequacy of Accident Prevention Facilities and Services) must file the DWC Form-105. Insurance companies are responsible for timely and accurately filing the DWC Form-105.