This version of the form is not currently in use and is provided for reference only. Download this version of Form DWC095 for the current year.
This is a legal form that was released by the Texas Department of Insurance - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is the Form DWC095 SIF Reimbursement Request Form?
A: It is a form used in Texas to request reimbursement for medical expenses related to an overturned order or designated doctor's opinion.
Q: Who can use the Form DWC095 SIF Reimbursement Request Form?
A: Anyone in Texas who has had an order overturned or a designated doctor's opinion can use this form to request reimbursement.
Q: What is SIF?
A: SIF stands for the Subsequent Injury Fund, which is a program that provides compensation to injured workers in Texas.
Q: What types of expenses can be reimbursed through the Form DWC095?
A: Medical expenses related to the overturned order or designated doctor's opinion can be reimbursed through this form.
Form Details:
Download a fillable version of Form DWC095 by clicking the link below or browse more documents and templates provided by the Texas Department of Insurance.