Texas DWC forms for injured workers

The first forms in the process — putting the Division and the insurance carrier on notice of your injury or a loved one's death.

DWC041 Employee's Claim for Compensation Most filed

The form that officially opens your workers' comp claim with the Division. You generally must file it within one year of a work-related injury, or of the date you knew an illness was job-related. Miss that deadline and you can lose the right to benefits entirely.

DWC042 Claim for Death Benefits

Surviving spouses, children, and other eligible family members use this form to claim death and burial benefits after a work-related death. It establishes who is entitled to benefits and starts the carrier's review. Strict filing deadlines apply.

DWC003ME Multiple Employment Wage Statement

If you held a second job when you were hurt, this statement reports those additional wages to the Division. Because Texas counts earnings from all your employers, it can raise your average weekly wage — and your weekly benefit. Pay stubs are usually required.

Apply for, adjust, accelerate, or take a lump sum of the weekly payments that replace the wages you lose.

DWC052 Supplemental Income Benefits (SIBs) Application

Supplemental income benefits are paid quarter by quarter to workers with a lasting impairment who meet strict work-search rules. This application documents your job searches or active work for the qualifying period. Each quarter requires a new, timely application.

DWC038 Application for Lifetime Income Benefits (LIBs)

Lifetime income benefits are reserved for the most catastrophic injuries — total blindness, loss of two limbs, certain spinal injuries, severe burns, or traumatic brain injury. This form applies for benefits that can continue for life. Strong medical proof is essential.

DWC039 First Responder's Annual LIBs Certification

A first responder already receiving lifetime income benefits files this each year to confirm they remain eligible. It certifies your status for the prior twelve months. Returning it late can interrupt your payments.

DWC051 Request a Lump Sum of Impairment Benefits (IIBs)

Instead of waiting out weekly impairment checks, you can ask to receive the remaining balance as a single lump sum. This form makes that request. Think it through \xe2\x80\x94 taking a lump sum can affect later benefits, so it is worth a conversation first.

DWC046 Request to Accelerate Impairment Benefits

This asks the insurance carrier to pay your impairment income benefits faster \xe2\x80\x94 a larger weekly amount over fewer weeks. The total stays the same; only the timing changes. It can help when you are facing immediate financial pressure.

DWC047 Request to Advance Benefits

If you are facing real financial hardship, you can request part of your income benefits up front. The advance is later repaid by reducing your future weekly checks. The Division weighs your hardship against the long-term effect on your payments.

DWC055 Adjust Average Weekly Wage (Seasonal)

Seasonal workers often earn very differently across the year, which can distort a standard average weekly wage. This form asks the Division to adjust that figure so your benefits better reflect real earnings. Documentation of your pay history helps.

Change your treating doctor, get reimbursed for travel, or handle issues tied to exams and surgery.

DWC053 Request to Change Treating Doctor

Your treating doctor coordinates your care and weighs in on key issues like impairment and return to work. If you are not in a comp health care network, this form asks the Division to approve a change. The first change is usually easier to get than later ones.

DWC048 Request Travel Cost Reimbursement

You can be reimbursed for traveling to medical appointments and exams more than 30 miles one way. This form documents your mileage and dates. Keep good records \xe2\x80\x94 appointments, addresses, and distances all support the request.

DWC032 Request a Designated Doctor Exam

A designated doctor is a neutral physician the Division appoints to settle disputed medical questions \xe2\x80\x94 impairment rating, maximum medical improvement, return to work, or whether an injury is related. This form requests that exam, and its opinion carries real weight.

DWC057 Extend MMI for Approved Spinal Surgery

Maximum medical improvement marks the point your condition is expected to stabilize, which affects your benefits. If you have had a Division-approved spinal surgery, this form asks to push that date back. Medical documentation of the surgery is required.

When treatment is denied, a rating is too low, or your benefits are wrong — the forms to challenge a decision and be heard.

DWC045 Schedule a Benefit Review Conference (BRC)

A benefit review conference is the first, informal step to resolve disputes over your claim with a Division mediator. Use this form to request, reschedule, or cancel one. Coming prepared with your evidence and a clear list of disputed issues makes a real difference.

DWC045A Request a Medical Contested Case or SOAH Hearing

When a medical fee dispute or an independent review (IRO) decision goes against you, this form requests a formal hearing to challenge it. Depending on the issue it may go to a Division judge or to the State Office of Administrative Hearings. Deadlines are short.

DWC045M Schedule a BRC to Appeal a Fee Dispute (BRC-MFD)

This requests a benefit review conference specifically to appeal a medical fee dispute decision. It works like a standard BRC but is tied to the fee-dispute track. Use it to schedule, move, or cancel that conference.

DWC049 Schedule a Medical Contested Case Hearing (MCCH)

A medical contested case hearing is where an IRO medical-necessity decision or a fee dispute is formally decided. This form requests that hearing. Because it is an evidentiary proceeding, having representation can be valuable.

DWC024 Benefit Dispute Agreement

When the parties agree on how to resolve a specific issue, this form records that agreement in writing. It settles the listed issues without giving up your right to pursue other matters later. Read it carefully \xe2\x80\x94 what you agree to here can bind you.

DWC025 Benefit Dispute Settlement

A settlement resolves all remaining disputed issues in your claim at once. You keep your right to lifetime medical care for the injury, but generally waive future proceedings on the settled issues. Because it is final, legal review before signing is strongly advised.

DWC044 Election to Engage in Arbitration

If a dispute remains unresolved after a benefit review conference, you can choose binding arbitration instead of a hearing. This form makes that election. Arbitration is final and binding, so it is a decision worth weighing carefully.

DWC058 Request for Interlocutory Order

While a dispute is still pending, this asks the Division to temporarily order benefits paid \xe2\x80\x94 or stopped \xe2\x80\x94 until the matter is decided. It is a way to address urgent needs in the meantime. The order is interim and can change once the dispute resolves.

DWC060 Medical Fee Dispute Resolution Request

Providers, carriers, and sometimes injured workers use this form when they disagree about how much should be paid for medical services. The Division reviews the billing against the fee guidelines to resolve it. Documentation of the charges is essential.

DWC154 Workers' Compensation Complaint Form

If you believe a carrier, employer, or other participant violated the Texas Labor Code or Division rules, you can file a formal complaint here. The Division reviews complaints and can take enforcement action. It does not, by itself, resolve a benefit dispute.