| Title |
Last Updated |
| Employers Contest Of Compensability |
April 13, 2015 |
| Designation Of Insurance Carriers Austin Representative |
April 13, 2015 |
| Request For A Medical Contested Case Or SOAH Hearing |
April 13, 2015 |
| Written Request For Interlocutory Order |
April 13, 2015 |
| Reclamo Del Empleado Para Compensacion Por Una Lesion Reclacionada Con El Trabajo O Enfermedad Ocupacional |
April 13, 2015 |
| Required Medical Examination Notice Or Request For Order |
April 13, 2015 |
| Request For Reimbursement Of Payment Made By Health Care Insurer |
April 13, 2015 |
| Notice To Employees Concerning Workers Compensation In Texas (Spanish) (Notice 6) |
April 13, 2015 |
| Notice To Employees Concerning Workers Compensation In Texas (Spanish) (Notice 5) |
April 13, 2015 |
| Notice To Employees Concerning Workers Compensation In Texas (Notice 5) |
April 13, 2015 |
| Notice To Employees Concerning Workers Compensation In Texas (Notice 6) |
April 13, 2015 |
| Employees Request To Change Treating Doctors (Non Network) (Spanish) |
April 13, 2015 |
| Request For Travel Reimbursement |
September 29, 2014 |
| Accident Prevention Services Annual Report w-Intsructions |
February 5, 2014 |
| Accident Prevention Services Worksheet |
February 5, 2014 |
| Employers Wage Statement |
June 19, 2013 |
| Application For Inclusion On Registry Of Private Providers Of Vocational Reahabilitation Services |
March 11, 2013 |
| Employers Report Of Non-Covered Employees Occupational Injury Or Disease |
January 12, 2013 |
| Employers Report Of Non-Covered Employees Occupational Injury Or Disease |
January 12, 2013 |
| Self Insured Governmental Entity Coverage Information |
August 13, 2012 |
| Election To Engage In Arbitration |
July 11, 2012 |
| Employees Request To Change Treating Doctors (Non Network) |
July 11, 2012 |
| Statement Of Pharmacy Services |
July 11, 2012 |
| Request To Schedule, Reschedule, Or Cancel A Benefit Review Conference (BRC) |
December 1, 2011 |
| Insurance Carrier Or Trading Partner Medical Electronic Data Interchange (EDI) Profile |
August 12, 2011 |
| Locations Of Employers Business(es) |
January 6, 2011 |
| Employers Wage Statement (Spanish) |
May 10, 2010 |
| Surety Bond Name Change Rider |
October 15, 2009 |
| Surety Bond Amount Rider |
October 15, 2009 |
| Parental Guaranty For Less Than Wholly Owned Subsidiary |
October 15, 2009 |
| Payment Of Compensation Or Notice Of Refused-Disputed Claim |
January 8, 2009 |
| Notice Of Fatal Injury Or Occupational Disease And Claim For Compensation For Death Benefits |
November 21, 2008 |
| Request For Designated Doctor |
November 14, 2008 |
| Private Providers Of Vocational Rehabilitation Services |
September 23, 2008 |
| Accident Prevention Plan Cover Sheet |
June 20, 2008 |
| Program Review Report w-Instructions |
June 20, 2008 |
| Application For Division Approval Of Purchase Of Annuity For Lifetime Income Benefits |
April 3, 2008 |
| Employer Request For DWC Safety Consultation |
April 3, 2008 |
| Application For Division Approval Of Change In Payment Period And Or Purchase Of Annuity For Death Benefits |
April 3, 2008 |
| Return-To-Work Pilot Program For Small Employers |
February 28, 2008 |
| Explanation Of Benefits |
December 28, 2007 |
| Reimbursement Rrequest For Payment Made By Health Care Insurer |
October 30, 2007 |
| Request For Benefit Review Conference |
October 30, 2007 |
| Employers Wage Statement For School Districts (Spanish) |
October 29, 2007 |
| Employers Wage Statement For School Districts |
October 29, 2007 |
| Medical Dispute Resolution Request-Response - And Table Of Disputed Services |
October 24, 2007 |
| Employees Request For Payment Of Advance Compensation |
October 23, 2007 |
| Employees Request For Payment Of Advance Compensation (Spanish) |
October 23, 2007 |
| Carriers Request For Seasonal Employee Wage Information From Texas Employment Commission Records |
October 23, 2007 |
| Notice Of Representation Or Withdrawl Of Representation |
October 23, 2007 |
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