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TWCC-85 (Rev. 07/04) Page 1 *F85P1-0704* TEXAS WORKERS COMPENSATION COMMISSION
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How to fill out twcc85 rev
How to fill out TWCC85 rev:
01
Start by downloading the TWCC85 rev form from the official website of the Texas Workers' Compensation Commission.
02
Fill in the date on the top right corner of the form. This should be the date on which you are filling out the form.
03
Enter your personal information, including your full name, address, phone number, and email address in the designated fields.
04
Provide the details of your employer, such as the company name, address, and contact information.
05
Indicate your job title and duties under the "Job Title and Description of Work" section.
06
Specify the date and time of the injury or illness that resulted in your workers' compensation claim.
07
Explain how the accident happened or how the illness developed in the "Description of Accident or Illness" section.
08
If applicable, include the names and contact information of any witnesses who can support your claim.
09
If you received any medical attention related to the injury or illness, provide details of the healthcare facility or doctor you visited.
10
Review the completed form for accuracy and ensure that all fields are properly filled out.
11
Sign and date the bottom of the form to confirm the authenticity of the information provided.
Who needs TWCC85 rev:
01
Employees who have had a work-related injury or illness and are seeking workers' compensation benefits may need to fill out TWCC85 rev.
02
The form is specifically required by the Texas Workers' Compensation Commission for individuals claiming workers' compensation.
03
Employers may also need the TWCC85 rev form to document and process workers' compensation claims filed by their employees.
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What is twcc85 rev?
twcc85 rev is a form used by the Texas Workers' Compensation Commission to report the final wages of an injured employee.
Who is required to file twcc85 rev?
Employers are required to file twcc85 rev for injured employees who are receiving workers' compensation benefits.
How to fill out twcc85 rev?
Employers must provide information such as the injured employee's name, social security number, wages, and other relevant details on the twcc85 rev form.
What is the purpose of twcc85 rev?
The purpose of twcc85 rev is to report the final wages of an injured employee to the Texas Workers' Compensation Commission.
What information must be reported on twcc85 rev?
Information such as the injured employee's name, social security number, wages, and other relevant details must be reported on twcc85 rev.
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