Texas Workers’ Comp Forms & Resources
Texas Required Postings and Forms
Please print and post the following notices, both in English and Spanish, in a conspicuous location frequented by employees such as the break room, lunch room or time clock. If you have multiple business locations, be sure to post the notices at each location.
- Notice 6: Notice to Employees Concerning Workers' Compensation in Texas (English and Spanish)
- Notice 9: Notice regarding certain work-related Communicable Diseases and Eligibility for Workers' Compensation Benefits (English and Spanish)
- Employer's Notice of Ombudsman Program to Employees (English and Spanish)
The following forms need to be completed and submitted to EMPLOYERS when a work-related injury occurs:
- Form DWC-1 Employer's First Report of Injury or Illness. The employer is required to submit this form with EMPLOYERS and the injured employee or the injured employee’s attorney within eight days after the employee’s absence from work or notice of the Injury or Illness. Fatalities must be reported to EMPLOYERS within 24 hours. Please use this form to notify EMPLOYERS of every work-related injury or disease suffered by an employee, regardless of severity.
- Form DWC-6 Supplemental Report of Injury. This form must be submitted by mail or personal delivery to EMPLOYERS and the injured employee. This form must be filed in the following situations and within the times frames that are indicated:
- Three days after the injured employee begins to lose time from work
- Three days after the injured employee returns to work
- Three days after the injured employee returns to work and has additional lost time
- Ten days after the end of each pay period in which the injured employee has a change in earnings
- Ten days after the injured employee resigns or is terminated
- Form DWC-41 Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease (English and Spanish). This form must be filed by the injured employee or a person acting on the injured employee’s behalf within one year of the date of injury or within one year from the date the injured employee knew or should have known the injury or disease may be work related.
- Form DWC-3 Employer's Wage Statement (English and Spanish). The purpose of this form is to provide the employee’s wage information to EMPLOYERS for calculating the employee’s average weekly wage to establish benefits. Please complete the form and submit it to EMPLOYERS within seven days after your knowledge of any accident that has caused your employee to be disabled for more than seven scheduled work calendar days.
- Notice of Injured Employee Rights and Responsibilities (English and Spanish). Employers are required to provide the injured employee a summary of rights and responsibilities at the time the report of injury is filed with EMPLOYERS. The employer is required to maintain a record of the date the copy of the report of injury and the summary of rights and responsibilities were provided to the injured employee.
- First Fill Form. This form provides your employees with basic information about our Pharmacy Benefit Program, including such things as the phone number to call to locate a First Fill participating pharmacy. When your employee becomes injured, please print and complete this form and provide it to your injured employee. Your employee will need to provide this completed form along with the prescription for his/her work-related injury or illness to the pharmacist. Using this form will help enable quick authorization for your employee’s initial medication and ensure that the initial prescription is provided at no cost to the injured employee.
The following is an additional form that an employer may complete and submit to EMPLOYERS after a work-related injury occurs:
- Form DWC-4 Employer’s Contest of Compensability. The employer has the right to contest a claim of an employee’s injury if EMPLOYERS accepts liability for the payment of benefits. The employer may contest the claim after presenting the grounds for non-compensability to EMPLOYERS and giving EMPLOYERS the opportunity to contest the claim.
Please print and review the following forms with new employees (at the time of hire):
- Notice to New Employees (English and Spanish). Employers must notify their employees of workers’ compensation coverage status in writing. This form must be provided to the employee at time of hire.
More Texas Workers’ Comp Resources
- Off-Site Transitional Duty Program - Helping Your Injured Employees Get Back to Work
A successful transition back to work relies on the collaborative efforts of the manager/supervisor, the injured employee and their adjuster. As a manager/supervisor, learn what you can do to help facilitate a successful return to work.