Get the free twcc 73 form
Show details
TCC 73 Rev. 06/00). Rule 129.5. TEXAS WORKERS' COMPENSATION COMMISSION. TEXAS WORKERS' COMPENSATION WORK STATUS REPORT ...
We are not affiliated with any brand or entity on this form
Get, Create, Make and Sign
Edit your twcc 73 form form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share your form instantly
Email, fax, or share your twcc 73 form form via URL. You can also download, print, or export forms to your preferred cloud storage service.
Editing twcc 73 online
Follow the guidelines below to take advantage of the professional PDF editor:
1
Register the account. Begin by clicking Start Free Trial and create a profile if you are a new user.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit twcc 73 pdf form. Text may be added and replaced, new objects can be included, pages can be rearranged, watermarks and page numbers can be added, and so on. When you're done editing, click Done and then go to the Documents tab to combine, divide, lock, or unlock the file.
4
Get your file. Select your file from the documents list and pick your export method. You may save it as a PDF, email it, or upload it to the cloud.
pdfFiller makes dealing with documents a breeze. Create an account to find out!
How to fill out twcc 73 form
How to fill out twcc 73:
01
Fill in your personal information such as your name, address, and contact details.
02
Provide the names of all parties involved in the workers' compensation claim, including the employer, employee, insurance carrier, and any representatives.
03
Indicate the date and place where the injury or illness occurred.
04
Describe the nature of the injury or illness and provide details about any medical treatment received.
05
Explain how the injury or illness is related to the employment and the specific tasks or conditions that caused it.
06
Document any previous injuries or conditions that may have contributed to the current injury or illness.
07
Sign and date the form to certify the information provided is accurate to the best of your knowledge.
Who needs twcc 73:
01
Employees who have suffered a work-related injury or illness and are seeking workers' compensation benefits.
02
Employers, insurance carriers, and representatives involved in the workers' compensation claim process.
03
Medical providers who are treating or assessing the injured employee and need to provide information about the injury or illness to support the claim.
Fill form : Try Risk Free
For pdfFiller’s FAQs
Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.
Who is required to file twcc 73?
The TWCC 73 form, also known as the Workers' Compensation Insurance Coverage Verification, is filed by employers in the state of Texas. Employers are required by law to file this form to provide information about their workers' compensation insurance coverage or the exemption from coverage.
How to fill out twcc 73?
The Texas Workers' Compensation Commision (TWCC) Form-73, also known as the Employee's Claim for Reimbursement of Travel Expenses, is used by employees to request reimbursement for travel expenses related to their workers' compensation claim. Here are the steps to fill out the TWCC 73 form:
1. Download the form: Visit the Texas Department of Insurance website or TWCC's official website to download a fillable PDF version of the TWCC 73 form.
2. Enter your personal information: Fill out your complete name, address, city, state, zip code, and contact number in the designated fields at the top of the form.
3. Provide your social security number: Record your social security number in the appropriate space provided.
4. Indicate the name of the insurance carrier: Enter the name of your employer's workers' compensation insurance carrier in the designated field.
5. Provide details about your employer: Fill in your employer's name, business address, city, state, zip code, and contact number in the corresponding spaces.
6. Specify the date of your accident or illness: Indicate the exact date when your work-related accident or illness occurred.
7. Describe your accident or illness: In the space provided, provide a detailed description of the incident that caused your work-related injury or illness.
8. Provide information about your medical treatment: Fill in the name and address of the healthcare provider(s) who treated you for your work-related injury or illness.
9. List your travel expenses: Next, create a list of all travel expenses you are seeking reimbursement for. Include the date of travel, purpose of the trip, mode of transportation used, the number of miles traveled, and the total amount claimed for reimbursement for each trip.
10. Calculate the total reimbursement amount: Add up all the amounts claimed and provide the total reimbursement amount in the space provided.
11. Sign and date the form: Sign and date the form at the bottom to certify that the information provided is accurate and true to the best of your knowledge.
12. Submit the form: Make a copy of the completed form for your records, and then submit the TWCC 73 to your employer or their workers’ compensation insurance carrier as instructed by your employer or the insurance company.
Make sure to follow any additional guidelines or instructions provided by your employer or the TWCC regarding the submission of the form.
What is the purpose of twcc 73?
TWCC 73 refers to a form used by the Texas Workers' Compensation Commission (TWCC), which has been replaced by the Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC). Unfortunately, I couldn't find specific information about a TWCC 73 form. It could either be outdated or specific to a particular situation or organization. It is recommended to contact the TDI-DWC or consult the relevant authority to get accurate information about the purpose of this form.
What information must be reported on twcc 73?
TWCC 73 is a form used by the Texas Department of Insurance's Division of Workers' Compensation to report the First Report of Injury or Illness. It is used to report work-related injuries or illnesses to the department within 8 days of the employer's knowledge of the injury or illness. The information that must be reported on TWCC 73 includes:
1. Employee information: The form must include the name, address, social security number, occupation, wage rate, and date of birth of the injured or ill employee.
2. Employer information: The form should include the legal name, address, and telephone number of the employer where the injury or illness occurred.
3. Accident information: Details about the accident or illness, such as the date and time of the incident, location of the accident, description of the event, and specific injury or illness sustained by the employee.
4. Medical treatment information: If the employee sought medical treatment, information about the treating physician or healthcare provider, the initial medical treatment provided, and the estimated return to work date should be included on the form.
5. Insurance information: If the employer has workers' compensation insurance, the carrier's name, address, and policy number should be provided on the form.
6. Witnesses: If there were any witnesses to the incident, their names and contact information should be reported.
It's worth noting that specific state regulations and requirements may vary, so it's always advisable to consult the Texas Department of Insurance website or a legal professional for the most accurate and up-to-date information regarding TWCC 73 form reporting.
How do I make edits in twcc 73 without leaving Chrome?
Add pdfFiller Google Chrome Extension to your web browser to start editing twcc 73 pdf form and other documents directly from a Google search page. The service allows you to make changes in your documents when viewing them in Chrome. Create fillable documents and edit existing PDFs from any internet-connected device with pdfFiller.
Can I sign the twcc 73 form electronically in Chrome?
As a PDF editor and form builder, pdfFiller has a lot of features. It also has a powerful e-signature tool that you can add to your Chrome browser. With our extension, you can type, draw, or take a picture of your signature with your webcam to make your legally-binding eSignature. Choose how you want to sign your twcc 73 printable forms 2019 and you'll be done in minutes.
How do I fill out twcc 73 form download using my mobile device?
You can easily create and fill out legal forms with the help of the pdfFiller mobile app. Complete and sign twcc 73 and other documents on your mobile device using the application. Visit pdfFiller’s webpage to learn more about the functionalities of the PDF editor.
Fill out your twcc 73 form online with pdfFiller!
pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.
Twcc 73 Form is not the form you're looking for?Search for another form here.
Keywords
Related Forms
If you believe that this page should be taken down, please follow our DMCA take down process
here
.