Texas Department of Insurance Forms

This form is used for disclosing certain information related to a vehicle transaction in the state of Texas. It provides details about the vehicle's history and any known issues or damages.

This form is used for reporting the results of a medical evaluation in Texas workers' compensation cases.

This document is used for requesting reimbursement for travel costs in Texas.

This is a Texas State form used for residential and small commercial construction contractors to establish the obligations between a hiring contractor and the independent contractor being hired in regards to workers' compensation insurance.

This document notifies an individual in Texas that their income benefits were underpaid. It provides information about the underpayment and instructions on how to address the issue.

This form is used for submitting a program review report in Texas.

This Form is used for submitting an Accident Prevention Plan Cover Sheet in the state of Texas.

This Form is used for Texas employers to request a safety consultation from the Texas Department of Workers' Compensation (DWC).

This Form is used for submitting the Annual Report for Accident Prevention Services in Texas. It is required by the Department of Workers' Compensation (DWC) to track and assess the effectiveness of accident prevention programs in the state.

This Form is used for obtaining a surety bond to cover certified self-insurance liabilities in the state of Texas.

This form is used for adding or changing the name of a surety bond rider in Texas.

This document is used for creating an irrevocable standby letter of credit in the state of Texas. It provides a guarantee of payment to the beneficiary in case the applicant fails to fulfill their obligations.

This Form is used for creating a legal agreement known as an Irrevocable Standby Letter of Credit with confirmation. It is specific to the state of Texas.

This Form is used for self-insurers in Texas to enter into an agreement to post a documentary irrevocable standby letter of credit.

This form is used for parental guaranty in the state of Texas. The form is used to secure payment for medical treatment given to a minor child by a healthcare provider.

This form is used for obtaining a parental guaranty for a subsidiary in Texas that is not fully owned.

This form is used for granting power of attorney in the state of Texas. It allows an individual (the principal) to appoint someone else (the agent) to make decisions and take legal actions on their behalf.

This form is used for obtaining a surety bond to cover assumed certified self-insurance liabilities in the state of Texas.

This document is used by employers in Texas to report any work-related injuries or illnesses suffered by their employees.

This type of document is a notice to employees in Texas about workers' compensation. It provides information about the benefits and rights related to workers' compensation in the state.

This form is used for Texas school districts to report wage information for employers.

This document provides information to employees in Texas regarding workers' compensation. It explains their rights and benefits in case of a work-related injury or illness.

This document provides employees in Texas with important information about workers' compensation, including their rights and responsibilities. It informs employees about the process for reporting workplace injuries and filing a claim for compensation.

This form is used for employers in Texas to apply for reimbursement through the Return-To-Work program.

This form is used for making corrections, revisions or endorsements to an existing insurance policy in the state of Texas.

This Form is used for making a claim for workers' compensation death benefits in the state of Texas.

This form is used for electing to engage in arbitration in the state of Texas.

This form is used for submitting a request to resolve a dispute over medical fees in Texas.

This form is used for requesting the continued use of a drug that was prescribed and dispensed, but is excluded from the Texas Department of Insurance Division of Workers' Compensation's closed formulary.

This form is used for reporting pharmacy services provided in the state of Texas.