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This document serves as a Power of Attorney allowing a designated agent to execute necessary documents related to self-insurance under the Texas Workers' Compensation Act.
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How to fill out dwc228
How to fill out DWC228
01
Locate the DWC228 form, which can typically be found on the relevant state or occupational health website.
02
Begin by filling in your personal information at the top of the form, including your name, address, and contact details.
03
Enter the details of the injury or illness, specifying the date of occurrence and the circumstances surrounding it.
04
Provide information about your employer and the job you were performing at the time of the incident.
05
Complete the section regarding medical treatment, including the names of any healthcare providers and the treatments received.
06
Review the form carefully to ensure all information is accurate and complete.
07
Sign and date the form to certify the information provided is true to the best of your knowledge.
08
Submit the DWC228 form to your employer or insurance carrier as instructed.
Who needs DWC228?
01
Employees who have sustained a work-related injury or illness and need to file a claim.
02
Employers who need to document workplace injuries to comply with state regulations.
03
Insurance companies that require the form to process workers' compensation claims.
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What is DWC228?
DWC228 is a form related to workers' compensation in California that is used to report information about an injured employee's claim.
Who is required to file DWC228?
Employers who have workers' compensation insurance and are reporting an injury to the California Division of Workers' Compensation must file DWC228.
How to fill out DWC228?
To fill out DWC228, you need to provide detailed information about the injured employee, the incident, and contact details of those involved, ensuring accuracy in all fields.
What is the purpose of DWC228?
The purpose of DWC228 is to collect necessary information about work-related injuries and to facilitate the claims process for injured workers.
What information must be reported on DWC228?
DWC228 requires information such as employer details, employee information, nature of the injury, date of injury, and any medical treatment received.
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