Texas Department of Insurance - Division of Workers' Compensation Forms

This checklist is used for guiding employers and employees in the state of Texas to safely return to work after a period of absence. It includes important steps and considerations to ensure a smooth transition back to the workplace.

This form is used for employers in Texas to contest the compensability of a worker's compensation claim.

This form is used for employers in Texas to notify the workers' compensation insurance agency when they have no coverage or are terminating their coverage.

This form is used for resolving benefit disputes in Texas. It helps parties involved in a dispute come to an agreement related to employee benefits.

This form is used for employees in Texas to file a claim for compensation if they have a work-related injury or occupational disease.

This Form is used by employees in Texas to file a claim for compensation for work-related injuries or occupational illnesses.

This document is a Spanish form used for electing to participate in arbitration in Texas.

This form is used for individuals in Texas who wish to elect to engage in arbitration for a legal dispute instead of going to court.

This Form is used for employers in Texas to apply for reimbursement under the Return-To-Work program.

This form is used for Texas employees to request a change of their treating doctor.

This document provides instructions for completing the ADA J515 Dental Claim Form specifically for Texas Workers' Compensation claims. It is a guide to help dental providers correctly fill out the form for reimbursement purposes.

This Form is used for resolving disputes regarding benefits in Texas. (Spanish)

This document is a Spanish form used in Texas to request an extension of the maximum medical improvement date for spinal surgery.

This form is used for reporting the locations of an employer's business(es) in the state of Texas.

This Form is used for requesting a medical contested case hearing for disputing medical benefits in Texas.

This form is used for carriers to request wage information for seasonal employees from the Texas Workforce Commission records in Texas.

This Form is used for informing employees about the intention to request permission from the division to adjust benefits in Texas.

This form is used for notifying an employee in Texas about the intention to request division permission to adjust their benefits.

This form is used for an agreement between a motor carrier and an owner operator in Texas to provide workers' compensation insurance or to require the owner operator to act as an employer.

This Form is used for an Agreement Between the Carrier and the Owner Operator to provide Workers' Compensation Insurance/Agreement to Require the Owner Operator to Act as an Employer - Texas (Spanish).

This document is a Spanish form used in Texas to request advanced benefits.