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ADVISORY 2004-12

SUBJECT: Revision of the TWCC-41 and TWCC-42

As part of the agency's ongoing Business Process Improvement initiative, an online application for filing a Notice of Injury or Occupational Disease and Claim for Compensation has been developed and is available on TXCOMP for employees, beneficiaries, and their representative to use in lieu of filing paper forms beginning September 16, 2004. To ensure consistency with the online system, the paper versions of these forms have been modified. The redesigned forms will also be electronically read by the Commission's new document management system in order to reduce manual data entry. To simplify the reporting processes, we have eliminated the TWCC-42 form. Instead, we will use the redesigned TWCC-41 to collect all basic employee first report information, and we have established a TWCC-41, Supplement A form that can be filed as a companion to the TWCC-41 when the claim is a fatality and these additional elements are applicable. The instructions and new forms are available for download at the following links:

The use of these new forms is required as of January 1, 2005, but is acceptable for use effective immediately. After this date, the old versions of the TWCC-41 and TWCC-42 will not be accepted. We will return these forms to the sender with the new form and request the new form be completed and resubmitted. Customers are encouraged to destroy blank copies of the old versions of these forms and begin using the new form immediately to ensure there is no delay in processing the Worker's or Beneficiary's Notice of Injury or Occupational Disease and Claim for Compensation. If you have any questions, contact the Customer Services Division at 512-804-4636 or send an e-mail to

Signed this 23rd day of November, 2004

Robert L. Shipe, Executive Director


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