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Advisory 96-03

EMPLOYEE RIGHTS AND RESPONSIBILITIES FORM

Rule 120.2(e) requires employers to provide injured workers with a summary of their rights and responsibilities at the same time that the Employer's First Report of Injury is filed with the insurance carrier. The Rule provides that the English and Spanish text provided by the Commission must be used without any changes or additional words.

The "Employee Rights And Responsibilities Under The Texas Workers' Compensation System" form published by the Commission (Pub. No. PI96-007A) must be used by employers to comply with the requirements of Rule 120.2(e). This form must be provided in the exact format and text as published by the Commission. The use of published brochures or other information is not a substitute for this form. Failure to use the published form will constitute non-compliance with this Rule.

While the employer may include other information or brochures, this form must be provided to the injured worker. Effective May 1, 1996, the most current version of this form published by the Commission must be used to comply with the provisions of Rule 120.2(e).

Signed March 28, 1996

Todd K. Brown, Executive Director



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