Get the free DWC Form-074 - tdi texas

Texas Department Of Insurance Treating Doctor Name Division of Workers Compensation Treating Doctor Telephone Number 7551 Metro Center Dr., Ste.100 Austin, TX 78744-1609 (512) 804-4000 (512) 804-4378

How to fill out dwc form-074 - tdi

How to fill out dwc form-074 - tdi:

1. First, gather all the necessary information to complete the form, such as the employee's personal details, employer information, and injury details.
2. Next, carefully read through the instructions provided on the form to ensure you understand the requirements and sections to be completed.
3. Begin by filling out the employee information section, including their name, address, social security number, and contact details.
4. Move on to the employer information section, providing details such as the company name, address, and contact information.
5. In the injury information section, describe the nature of the injury or illness and the date it occurred. Include any additional details requested, such as the specific body part affected.
6. If there were witnesses to the incident, provide their names and contact information in the relevant section.
7. The next section typically requires the treating physician's information. Include their name, address, and contact details.
8. In the wage information section, enter the employee's average weekly earnings prior to the injury.
9. If the employee is entitled to any benefits, such as temporary disability or supplemental job displacement benefits, provide the requested information in the benefits section.
10. Finally, review the completed form for accuracy and completeness before submitting it to the appropriate party.

Who needs dwc form-074 - tdi?

1. Employers who have an employee that has been injured or developed an occupational disease while on the job may need to fill out the dwc form-074 - tdi.
2. Employees who have sustained an injury or developed an occupational disease and wish to file a workers' compensation claim may need this form as well.
3. Insurance carriers and claims administrators may also require this form to process and manage workers' compensation claims.

For pdfFiller’s FAQs

What is dwc form-074 - tdi?

The DWC form-074 - TDI is a form used for reporting Temporary Disability Insurance (TDI) benefits.

Who is required to file dwc form-074 - tdi?

Employers are required to file the DWC form-074 - TDI for employees who are receiving TDI benefits.

How to fill out dwc form-074 - tdi?

The DWC form-074 - TDI can be filled out online or manually. Employers must provide information about the employee, their TDI benefits, and the period of disability.

What is the purpose of dwc form-074 - tdi?

The purpose of the DWC form-074 - TDI is to report and track TDI benefits paid to employees.

What information must be reported on dwc form-074 - tdi?

Information such as the employee's name, social security number, date of disability, amount of TDI benefits paid, and any other relevant details must be reported on the DWC form-074 - TDI.

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