Get the free DWC-74 - Texas Department of Insurance - Texas.gov

CLAIM # Carrier #SUPPLEMENTAL REPORT OF INJURY Part EMPLOYER INFORMATION1. Employer business name2. Employer phone #3. Employer mailing address 4. Insurance carrier name5. Does the employer have return

How to fill out dwc-74 - texas department

How to fill out dwc-74 - texas department

1. To fill out DWC-74 - Texas Department, follow these steps:
2. Start by obtaining the DWC-74 form from the Texas Department of Workers' Compensation website or their office.
3. Read the instructions carefully to understand the purpose and requirements of the form.
4. Begin filling out the form by providing your personal information such as your name, address, and contact details.
5. Enter your employer's information, including their name, address, and contact details.
6. Specify the date and time of your injury or illness.
7. Describe your injury or illness in detail, including the body parts affected and the circumstances surrounding the incident.
8. Provide information about the medical treatment you have received for the injury or illness.
9. Include any supporting documentation such as medical reports or bills.
10. Review the completed form for accuracy and completeness.
11. Sign and date the form before submitting it to the Texas Department of Workers' Compensation.
12. Keep a copy of the filled-out form for your records.

Who needs dwc-74 - texas department?

1. DWC-74 - Texas Department is required by individuals who have suffered a work-related injury or illness in the state of Texas.
2. Employees who have been injured on the job and are seeking workers' compensation benefits should fill out this form to initiate the claims process.
3. Employers may also need to use this form to report injuries or illnesses suffered by their employees.
4. Healthcare professionals treating injured workers may need to fill out this form to provide necessary information for the claims process.

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What is dwc-74 - texas department?

The DWC-74 is a form utilized by the Texas Department of Workers' Compensation for reporting work-related injuries and illnesses.

Who is required to file dwc-74 - texas department?

Employers are required to file the DWC-74 form with the Texas Department of Workers' Compensation.

How to fill out dwc-74 - texas department?

The DWC-74 form must be completed with details of work-related injuries and illnesses, including the date of occurrence, nature of injury, and treatment received.

What is the purpose of dwc-74 - texas department?

The purpose of the DWC-74 form is to track and monitor work-related injuries and illnesses in the state of Texas.

What information must be reported on dwc-74 - texas department?

The DWC-74 form requires information such as the injured worker's details, employer information, date and details of the injury, and medical treatment received.