The Texas Workers’ Compensation Commission announced that as a part of the agency’s ongoing Business Process Improvement initiative, an online application for filing a Notice of Injury or Occupational Disease and Claim for Compensation has been developed and is available on TXCOMP for employees, beneficiaries, and their representative to use in lieu of filing paper forms effective Sept. 16, 2004. To ensure consistency with the online system, the paper versions of these forms have been modified.
The redesigned forms will also be electronically read by the Commission’s new document management system in order to reduce manual data entry. To simplify the reporting processes, the agency eliminated the TWCC-42 form. Instead, it will use the redesigned TWCC-41 to collect all basic employee first report information. A TWCC-41, Supplement A form was established that can be filed as a companion to the TWCC-41 when the claim is a fatality and these additional elements are applicable.
The instructions and new forms are available for download at the following links:
Instructions/Form for the TWCC-41, Worker’s or Beneficiary’s Notice of Injury or Occupational Disease and Claim for Compensation
English Version: http://www.twcc.state.tx.us/forms/pdf/twcc41.pdf
Spanish Version: http://www.twcc.state.tx.us/forms/pdf/twcc41s.pdf
Instructions/Form TWCC-41, Supplement A, Beneficiary’s Claim for Compensation
English Version: http://www.twcc.state.tx.us/forms/pdf/twcc41a.pdf
Spanish Version: http://www.twcc.state.tx.us/forms/pdf/twcc41as.pdf
The use of these new forms is required as of Jan. 1, 2005, but is acceptable for use effective immediately. After Jan. 1, the old versions of the TWCC-41 and TWCC-42 will not be accepted. Those forms will be returned to the sender with the new form and a request that the new form be completed and resubmitted. Customers are encouraged to destroy blank copies of the old versions of these forms and begin using the new form immediately to ensure there is no delay in processing the Worker’s or Beneficiary’s Notice of Injury or Occupational Disease and Claim for Compensation.
For more information, contact the Customer Services Division at (512) 804-4636 or e-mail email@example.com.
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