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Workers Compensation Network Acknowledgement I have received information that tells me how to get health care under workers' compensation insurance. If I am hurt on the job and live in the service
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Start by downloading the www.tdi.texas.gov/forms/finmcqas/n004_0415 form from the website.
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Any employer or employee in Texas who is involved in a workers compensation claim may need to fill out the www.tdi.texas.gov/forms/finmcqas/n004_0415 form.
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This form is used to report workers compensation insurance coverage information to the Texas Department of Insurance.
Employers in Texas who provide workers compensation insurance coverage for their employees are required to file this form.
The form should be filled out with information about the employer, insurance carrier, policy number, coverage period, and other relevant details. It can be submitted online or by mail to the Texas Department of Insurance.
The purpose of this form is to ensure that employers in Texas have workers compensation insurance coverage for their employees, as required by law.
Information such as employer details, insurance carrier information, policy number, coverage period, and any changes in coverage must be reported on this form.
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