Claim for Workers Compensation Death Benefits

You must turn in this form to the Texas Department of Insurance, Division of Workers’ Compensation (DWC) or the insurance carrier no later than one year after the employee’s death. After one year, you can only get death benefits if: • You …

2023年3月3日 · Texas Department of Insurance 1601 Congress Avenue, Austin, TX 78701 | PO Box 12050, Austin, TX 78711 | 512-804-4000 | 800-252-7031

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2015年5月27日 · The Division has made slight revisions to the DWC-42, the form used by death beneficiaries to claim death benefits under the act. The revisions provide instruction on how to contact DWC regarding questions about the form or claims and how to locate the Spanish version of the DWC-42 Form on the Texas Department of Insurance website.

You must file a form DWC-42 or apply online at TXCOMP. Send the completed DWC Form-042 to the TDI-DWC at the following address: Texas Department of Insurance, Division of Workers' Compensation 7551 Metro Center Drive, Suite 100, MS-94 Austin, Texas, 78744-1645 The application for death benefits should include proof of...

2024年1月23日 · Also, the DWC-42 form (Claim for Workers’ Compensation Death Benefits) has been modified to help eligible beneficiaries file claims for death benefits with DWC or an insurance carrier. This form can be found on the DWC website at https://www.tdi.texas.gov/forms/dwc/dwc042benclm.pdf and is effective immediately.

Division of Workers' Compensation . WORKERS' COMPENSATION APPEALS BOARD . STATE OF CALIFORNIA ) ) Case No.) Applicant,) vs. ) ) PETITION TO REOPEN ) ) ) Defendants) Petitioner hereby requests that the above-entitled action be reopened for the following reasons: DWC/WCAB FORM 42 (REV. 8-85) Title: WORKERS' COMPENSATION APPEALS BOARD

• Pay full DIB payment apportioned between all eligible beneficiaries who have filed DWC-42’s. Upon filing of new DIB claim, determine eligibility and pay per reapportionment including accrued benefits