Get the free dwc form 85 pdf - tdi texas

Texas Department of Insurance Division of Workers Compensation 7551 Metro Center Drive, Suite 100 Austin, Texas 78744-1609 512-804-4000 512-804-4346 fax www.tdi.state.tx.us Si used no est Segura is

How to fill out dwc form 85 pdf

How to fill out DWC form 85 PDF:

1. Start by downloading the DWC form 85 PDF from a reliable source or obtain it from your employer or insurance company.
2. Open the PDF file using a PDF reader or editor software on your computer or device.
3. Begin filling out the form by entering your personal information such as your name, address, phone number, and email address in the designated fields.
4. Provide details about your employer, including the company name, address, and contact information.
5. Specify the date of the injury or illness that caused you to seek workers' compensation benefits.
6. Describe the circumstances surrounding the incident in detail, explaining how and where the injury or illness occurred.
7. Indicate whether you sought medical treatment, including the name and contact information of the healthcare provider.
8. Fill in the details of any witnesses to the incident, if applicable, providing their names and contact information.
9. If you were not able to work due to the injury or illness, indicate the dates of missed work and any wages lost.
10. Sign and date the form to certify that the information provided is true and accurate to the best of your knowledge.

Who needs DWC form 85 PDF:

1. Employees who have been injured or become ill while at work and are seeking workers' compensation benefits.
2. Employers or insurance companies who are responsible for processing workers' compensation claims and need to gather information about the incident.
3. Medical professionals who have treated an individual for a work-related injury or illness and need to provide documentation for the workers' compensation claim.

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What is dwc form 85 pdf?

DWC Form 85 PDF is a form used for reporting work-related injuries and illnesses to the Division of Workers' Compensation.

Who is required to file dwc form 85 pdf?

Employers are required to file DWC Form 85 PDF for any work-related injuries and illnesses that occur in the workplace.

How to fill out dwc form 85 pdf?

To fill out DWC Form 85 PDF, you need to provide information about the injured employee, the nature of the injury or illness, and the details of the incident.

What is the purpose of dwc form 85 pdf?

The purpose of DWC Form 85 PDF is to ensure that work-related injuries and illnesses are properly reported and recorded for workers' compensation purposes.

What information must be reported on dwc form 85 pdf?

Information such as the employee's name, date of injury, description of injury, medical treatment received, and any other relevant details must be reported on DWC Form 85 PDF.