PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form DWC095
for the current year.
Form DWC095 Sif Reimbursement Request Form - Overturned Order or Designated Doctor Opinion - Texas
What Is Form DWC095?
This is a legal form that was released by the Texas Department of Insurance - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the Form DWC095 SIF Reimbursement Request Form?A: It is a form used in Texas to request reimbursement for medical expenses related to an overturned order or designated doctor's opinion.
Q: Who can use the Form DWC095 SIF Reimbursement Request Form?A: Anyone in Texas who has had an order overturned or a designated doctor's opinion can use this form to request reimbursement.
Q: What is SIF?A: SIF stands for the Subsequent Injury Fund, which is a program that provides compensation to injured workers in Texas.
Q: What types of expenses can be reimbursed through the Form DWC095?A: Medical expenses related to the overturned order or designated doctor's opinion can be reimbursed through this form.
Form Details:
- Released on November 1, 2018;
- The latest edition provided by the Texas Department of Insurance;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form DWC095 by clicking the link below or browse more documents and templates provided by the Texas Department of Insurance.
Download Form DWC095 Sif Reimbursement Request Form - Overturned Order or Designated Doctor Opinion - Texas
1
2
3
4
5
6
