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 |
|
| 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 |
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