Workers' Compensation Requests for Workers' Compensation Claim File Information
Division of Workers Compensation Main Forms page
English
| Information in or derived from a claim file regarding a Workers' compensation claimant is confidential and may not be disclosed except as provided in the Texas Workers' Compensation Act. Because of the confidential nature of claimant information, REQUESTS FOR CLAIM FILE INFORMATION WILL NOT BE ACCEPTED VIA INTERNET E-MAIL OR FAX. The following forms for requesting confidential claimant information can be downloaded from this website. These request forms may be hand-delivered or submitted via mail to: Texas Department of Insurance, Division of Workers' Compensation 7551 Metro Center Drive, MS-92B Austin, Texas 78744-1609 | ||
| TDI Form Number | Description | File Format |
|---|---|---|
| DWC153 | Request for Copies of Confidential Claimant Information (Rev. 10/06) - Effective September 1, 2006, requests for a claim file, medical dispute resolution file, and/or an indemnity resolution file must be made on the newly revised DWC-153 form (10/2006). A requestor must be eligible by statute to receive the |
|
| DWC155 | Request for Record Check (Rev. 10/05) |
|
| DWC156 | Prospective Employment Authorization and Certification (Rev. 10/05) |
|
En Español
| Número del Formulario de TDI | Descripción | Formato del Archivo |
|---|---|---|
| DWC153s | Solicitud para Obtener Copias de la Información Confidencial del Reclamante (Rev. 07/08) |
|
| DWC156S | Certificación Y Autorización De Un Posible Empleo (Rev. 10/06) |
For more information contact:
