Workers’ Comp Form DWC-041: Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease

Hello, my name’s Kim Wyatt. I’m the running attorney right here at Bailey & Galyen for the Workers’ Comp division.

Right now, we’re likely to examine a kind that quite a few of you will and need to have stuffed out, if you are reporting that you have been hurt on the work in Texas. This type selection is DWC-041. There’s pretty a several boxes and sections that you require to fill out.It is always excellent to fill out as substantially as feasible. Points like your title, social, date of beginning, mobile phone selection, electronic mail tackle if you have it. A bit about your employer, what your function position is, if you are ready to operate, if it’s restricted, the day you had been hired, profession at the time of the personal injury.

One particular thing I would ask that you be very careful about when you fill out this sort is portion two, the injury info. There is two styles of accidents in workers’ comp, one is a distinct injuries, you’d know exactly when that happened, the moment it happened. And then there is the occupational health conditions which took place above a period of time. All those you may possibly not know accurately the day that they happened, so be cautious when you fill out the kind due to the fact you need to make the final decision and commonly it ought to be a quite basic choice as significantly as, is this some thing that transpired over time, or if it’s a specific occasion. That is undoubtedly some thing you would want to get in touch with us about and we can enable you determine that out for the reason that it will make any difference down the road.

I will explain to you I have observed that the carriers do are inclined to dispute the occupational diseases pretty swiftly. So that’s why you will need to be very careful with that variety. You then want to fill the form out and submit it to the division of workers’ comp. You can possibly fax it or mail it and get it above to them so that you can create that you have been wounded on the career. In Texas, you have a person calendar year to fill this out. A whole lot of folks might be like “that’s lots of time”. But the insurance plan provider can be doing what they are accomplishing for you, you’re receiving your benefits, you’re observing a doctor, following point you know you did not comprehend you did not experience this out within just a yr, so it will go by. I just propose every person file it, you’ll get a declare number with a division and that would be what you would use anytime you called in the division.

So, if you will need support with this surely give us a simply call listed here at Bailey and Galyen. We can certainly enable you fill out the DWC-041 type. Thank you.