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.
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.
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.
DWC042
Who can get death benefits? When a person dies due to a work-related injury or illness, certain family members may be able to get death benefit payments. The family members who can get death benefits are called beneficiaries. Beneficiaries include: The wife or husband of the person who died. Children and stepchildren of the person […]
PLN12
Instructions to the insurance carrier: Notice of Potential Entitlement to Workers’ Compensation Death Benefits (PLN-12) 28 Texas Administrative Code (TAC) Sections 124.8 and 132.17 The insurance carrier must use this notice to notify a person identified as a potential beneficiary about their potential entitlement to receive death benefits and how to file a claim for […]