TX DWC048 2021-2025 free printable template
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DWC048
Complete if known:
DWC Claim #
Insurance Carrier Claim #
Request to get reimbursed for travel costs
Ester formulation ESTA disposable en Español en El site web DE la Division en
www.tdi.texas.gov/forms/dwc/dwc048trvlreims.pdf
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TX DWC048 Form Versions
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How to fill out
How to fill out TX DWC048
01
Begin by entering the date on the form.
02
Fill in the employee's information, including their name, address, and Social Security number.
03
Provide the employer's information, including the company's name and address.
04
Complete the details of the accident, including the date it occurred and a description of what happened.
05
Indicate the nature of the injury and any medical treatment that has been received.
06
Sign and date the form, certifying that the information provided is accurate.
Who needs TX DWC048?
01
Employees who have sustained a work-related injury or illness.
02
Employers who need to report the injury to their workers' compensation insurance.
03
Medical providers who are involved in the treatment of the injured employee.
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People Also Ask about
What is the Texas state Comptroller mileage rate for 2023?
The State of Texas Comptroller announced that the state mileage reimbursement rate effective January 1, 2023 to December 31, 2023 is 65.5 cents per mile. This is an increase from the January 2022 calendar year rate of 62.5 cents per mile.
How do I file a workers comp claim in Texas?
Call 800-252-7031, option 1. Workers' compensation is an insurance program managed by the State of Texas. It provides pay and medical benefits to employees who have a work-related injury or illness.
What is fair compensation for mileage?
What is the current federal mileage reimbursement rate? The current, 2023 federal mileage rate: 65.5 cents per mile for business purposes. 22 cents per mile for medical and moving purposes.
How much does workers comp reimburse for mileage in Texas?
Effective July 1 – December 31, 2022, the automobile mileage reimbursement rate is 62.5 cents per mile. Effective January 1 – June 30, 2022, the automobile mileage reimbursement rate is 58.5 cents per mile. Grantees may claim reimbursement retroactively for this rate for the effective dates.
How much does Texas workers Comp pay for mileage?
What is the Mileage Reimbursement Rate for 2021? What Does The Rate Change Mean? The new rate means that, regardless of your date of injury, if you incur mileage during the year of 2022, that is reimbursable, you will receive $. 58.5, per mile.
What does Texas workers Comp pay?
Injured workers in Texas are eligible for temporary income benefits when they have lost money from a job for more than seven days due to a work-related injury. Those days do not have to be in the same week or consecutive. Temporary benefits amount to 70 or 75% of what the worker's average weekly wage before the injury.
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What is TX DWC048?
TX DWC048 is a form used in Texas for reporting specific information regarding workers' compensation claims, particularly related to injury or illness claims.
Who is required to file TX DWC048?
Employers, insurance carriers, and other entities involved in the workers' compensation system in Texas are required to file TX DWC048 when necessary.
How to fill out TX DWC048?
To fill out TX DWC048, you need to provide detailed information about the injured worker, the nature of the injury, the circumstances surrounding the incident, and any relevant medical treatment information.
What is the purpose of TX DWC048?
The purpose of TX DWC048 is to ensure accurate reporting of workers' compensation claims, facilitating the processing of those claims and providing necessary information to various stakeholders.
What information must be reported on TX DWC048?
The information that must be reported on TX DWC048 includes the employee's details, injury specifics, date of injury, medical treatment authorized, and any other relevant claims information.
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