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To:Texas Workers Compensation System ParticipantsFrom:Erica De La Cruz, Deputy Commissioner for Claims and Customer ServicesDate:December 19, 2023Subject: Revised DWC Form042, Claim for Workers Compensation

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How to fill out revised dwc form-042 claim

01

To fill out the revised DWC Form-042 claim, follow these steps:

02

Start by providing your name, address, and other contact information in the designated fields.

03

Provide information about your employer, including their name, address, and contact information.

04

Specify the date and time when the injury or illness occurred.

05

Describe the injury or illness in detail, including the body parts affected and the circumstances surrounding the incident.

06

If you sought medical treatment, provide information about the healthcare provider you visited.

07

Indicate whether you have any prior medical conditions that may have contributed to the current injury or illness.

08

If you have any witnesses who can support your claim, provide their names and contact information.

09

Sign and date the form to certify the accuracy of the information provided.

10

Make a copy of the completed form for your records before submitting it to the appropriate authorities.

Who needs revised dwc form-042 claim?

01

Any individual who has suffered a work-related injury or illness and wishes to file a claim for workers' compensation benefits needs the revised DWC Form-042 claim. It is required by the relevant authorities to initiate the claims process and provide accurate information about the incident and resulting injuries or illnesses.

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What is revised dwc form-042 claim?

The revised DWC Form-042 claim is a form used to submit a request for a correction or adjustment to a previously filed claim relating to workers' compensation benefits in certain jurisdictions.

Who is required to file revised dwc form-042 claim?

Employers or their representatives, as well as injured workers or their representatives, may be required to file a revised DWC Form-042 claim if there are discrepancies or changes needed in a previously submitted claim.

How to fill out revised dwc form-042 claim?

To fill out the revised DWC Form-042 claim, ensure to provide accurate personal information, details of the original claim, the reasons for the revision, and any necessary documentation to support the requested adjustments.

What is the purpose of revised dwc form-042 claim?

The purpose of the revised DWC Form-042 claim is to allow claimants to officially request modifications or corrections to their original claims to ensure they receive the appropriate benefits or adjustments.

What information must be reported on revised dwc form-042 claim?

The information that must be reported includes claimant details, original claim number, reasons for the revision, supporting documentation, and any updated information that affects the claim.

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