Hi, my name’s Kim Wyatt. I’m the managing attorney here at Bailey & Galyen for the Workers’ Comp department.
Today, we’re going to discuss a form that many of you will and should have filled out, if you are reporting that you have been injured on the job in Texas. This form number is DWC-041. There are quite a few boxes and sections that you need to fill out. It’s always good to fill out as much as possible. Things like your name, social security number, date of birth, phone number, email address if you have it. A bit about your employer, what your work status is, if you’re able to work, if it’s restricted, the date you were hired, occupation at the time of the injury.
One thing I would ask that you be careful about when you fill out this form is section two, the injury information. There’s two types of injuries in workers’ comp. One is a specific injury—you’d know exactly when that happened, the moment it happened. And then there’s the occupational diseases, which happened over a period of time. Those you may not know exactly the date that they occurred, so be careful when you fill out the form because you need to make the decision, and usually it should be a fairly plain decision as far as is this something that occurred over time, or if it’s a specific event. That is definitely something you would want to call us about, and we can help you figure that out because it will matter down the road.
I will tell you I’ve noticed that the carriers do tend to dispute the occupational diseases quite quickly. So that’s why you need to be careful with that form. You then need to fill the form out and submit it to the Division of Workers’ Comp. You can either fax it or mail it and get it over to them so that you can establish that you’ve been injured on the job.
In Texas, you have one year to fill this out. A lot of people might be like, That’s plenty of time. But the insurance carrier can be doing what they’re doing for you: you’re getting your benefits, you’re seeing a doctor … next thing you know you didn’t realize you didn’t fill this out within a year, so it will pass by.
I just recommend everybody file it. You’ll get a claim number with a division and that would be what you would use anytime you called in the division.
So, if you need help with this definitely give us a call here at Bailey and Galyen. We can definitely help you fill out the DWC-041 form. Thank you.
