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Form TDI45(Rev.1/2000) Human Resource ServicesBYUHawaii55220 Fulani St. ×1969 Late, HI 96762CLAIM FOR DISABILITY BENEFITSPART A CLAIMANTS STATEMENT 1. My name is: (First, middle, last) Type or print2.
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Form TDI-45 is a document used for reporting workplace injuries and illnesses to the Texas Department of Insurance, Division of Workers' Compensation.
Employers in Texas are required to file form TDI-45 if one or more of their employees suffer a work-related injury or illness.
Form TDI-45 can be filled out online on the Texas Department of Insurance website or submitted by mail. Employers need to provide information about the injured employee, the nature of the injury or illness, and the circumstances surrounding the incident.
The purpose of form TDI-45 is to report work-related injuries and illnesses to the Texas Department of Insurance for recordkeeping and statistical analysis purposes.
Employers must report information such as the injured employee's name, date of birth, date of injury, nature of injury or illness, and any medical treatment received.
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