TX DWC Form-73 2011 free printable template

Employee You are required to report your injury to your employer within 30 days if your employer has workers' compensation insurance. You have the right to free assistance from the Texas Department

How to fill out TX DWC Form-73

How to fill out TX DWC Form-73

1. Obtain the TX DWC Form-73 from the Texas Department of Insurance website or your employer.
2. Enter the required information in the designated fields, including your name, address, and contact information.
3. Fill out the details of the injury or illness, including the date of injury, location, and description.
4. Provide information about your employer and the insurance provider.
5. Complete any additional sections that apply to your specific situation.
6. Review the form for accuracy and completeness.
7. Sign and date the form at the designated section.
8. Submit the completed Form-73 to the appropriate party (employer or insurance provider).

Who needs TX DWC Form-73?

1. Employees who have sustained a work-related injury or illness.
2. Employers who need to document and submit a claim for workers' compensation.
3. Healthcare providers involved in the treatment of the injured employee.

People Also Ask about

What is a DWC 7 form?

DWC-7 Notice to Employees-Injuries Caused by Work (English and Spanish). This form provides your employees with information regarding workers' compensation benefits and the Medical Provider Network (MPN) in California.

What is a DWC court?

The Division of Workers' Compensation (DWC) monitors the administration of workers' compensation claims, and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers' compensation benefits.

What is a DWC notice?

Division of Workers' Compensation Notice to Employees--Injuries Caused By Work. You may be entitled to workers' compensation benefits if you are injured or become ill because of your job. Workers' compensation covers most work-related physical or mental injuries and illnesses.

Who is exempt from workers compensation insurance in Texas?

However, there are exclusions to this rule for some employers listed below: Any public employer including cities, counties, state agencies and state universities. Building and construction contractors for public employers. Motor bus companies and motor carriers.

Is workers compensation insurance mandatory in Texas?

Texas Law. Requires all employers, with or without workers' compensation insurance coverage, to comply with reporting and notification requirements under the Texas Workers' Compensation Act. Provides for reimbursement of medical expenses and a portion of lost wages due to a work-related injury, disease, or illness.

What is a DWC 3 wage statement Texas?

A DWC-3 is an Employer's Wage Statement form outlined by the Texas Department of Insurance, Division of Workers' Compensation (DWC). Texas Mutual uses this form to determine the injured employee's average weekly wage and calculate financial assistance for them or their beneficiary.

Does a single member LLC need workers compensation insurance in Texas?

In most cases, as a single-member limited liability corporation (LLC), you may not be required by your state to have workers' compensation coverage. However, you might choose to obtain coverage once you see what workers' compensation insurance can do to protect your assets.

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What is TX DWC Form-73?

TX DWC Form-73 is a document used in Texas for reporting an employer's claim of immunity from liability under the state's workers' compensation law.

Who is required to file TX DWC Form-73?

Employers who wish to assert a claim of immunity for an employee's workplace injury must file TX DWC Form-73.

How to fill out TX DWC Form-73?

To fill out TX DWC Form-73, employers should provide required information such as the employer's details, employee's information, incident details, and the rationale for asserting immunity.

What is the purpose of TX DWC Form-73?

The purpose of TX DWC Form-73 is to formally document an employer's assertion of immunity from liability for certain workplace injuries under Texas law.

What information must be reported on TX DWC Form-73?

TX DWC Form-73 must report information such as the employer's name and address, employee's name and address, date of injury, details of the incident, and the basis for the immunity claim.