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You are here: www.tdi.texas.gov . forms . form20request

Workers' Compensation Requests for Workers' Compensation Claim File Information

This is one of several pages linking to a central repository of forms used by TDI customers. Use the search or Forms by Type links on the Forms Home Page or scan through our form listings.

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

Division of Workers Compensation Main Forms page

Workers' Compensation Requests for Workers' Compensation Claim File Information
TDI Form Number Description File FormatLanguage
DWC153 Request for Copies of Confidential Claimant Information
Rev. 10/06
PDFEnglish
DWC153s Solicitud para Obtener Copias de la Información Confidencial del Reclamante
Rev. 07/08
PDFEnglish
DWC155 Request for Record Check
Rev. 10/05
PDFEnglish
DWC156 Prospective Employment Authorization and Certification
Rev. 10/05
PDFEnglish
DWC156S Certificación Y Autorización De Un Posible Empleo
Rev. 10/06
PDFSpanish


For more information contact:

Last updated: 09/17/2014

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Translation by WorldLingo


Translation by WorldLingo