• Increase Text Icon
  • Decrease Text Icon
  • Email Icon
  • Print this page
You are here: Home . wc . news . advisories . ad2004-11

ADVISORY 2004-11

SUBJECT: New Form TWCC-150, Notice of Representation or Withdrawal of Representation

As part of the agency's ongoing Business Process Improvement initiative, the Commission has developed a new form for Union Representatives, Lay Representatives, or Attorneys to notify TWCC of their representation or the withdrawal of representation. The form must be signed by the employee or the beneficiary for the representation to take effect. However, either party can complete the withdrawal of representation section without having the other party's signature on the form.

Attorneys or representatives that are already associated as a representative on a TWCC claim file do not need to complete a new TWCC-150 for those claims. This exception applies only to those who have Letters of Representation or Powers of Attorney already on file with TWCC. That information will be transferred to the TXCOMP system. For notice of representation not already provided to the Commission, immediate use of the new TWCC-150 is recommended. Use of this form will be required effective November 1, 2004. The form must be signed by both the claimant (or beneficiary) and the representative and provided to the insurance carrier and the Commission.

The Commission will be using this information to ensure we have the correct representative on file for a specific claim, to ensure correspondence or contact regarding the claim is routed to or through the appropriate representative, and to ensure that online access to the TXCOMP confidential claim file information can be made available to the correct representative of record. In addition to appropriate notice of representation, a System Access Request Form (SARF) will be required for TXCOMP access to the claim. The new TWCC-150 form with instructions is available for download at the following link:

Instructions/Form for the TWCC-150, Notice of Representation or Withdrawal of Representation

If you have any questions, contact the Customer Services Division at 512-804-4636 or at WorkersCompCustomerServices@tdi.texas.gov.

Signed this 30th day of September, 2004

Robert L. Shipe, Acting Executive Director

Distribution:

TWCC Staff
Medical Professional Associations
Carrier Representatives
Forms Notification List
Public Information List
TWCC website



Contact Information and Other Helpful Links