Form DWC097 Subsequent Injury Fund Reimbursement Request Form - Multiple Employment - Texas

Form DWC097 Subsequent Injury Fund Reimbursement Request Form - Multiple Employment - Texas

What Is Form DWC097?

This is a legal form that was released by the Texas Department of Insurance - Division of Workers' Compensation - 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 DWC097?A: Form DWC097 is the Subsequent Injury Fund Reimbursement Request Form.

Q: What does the Form DWC097 cover?A: The Form DWC097 covers reimbursement requests related to multiple employment in Texas.

Q: What is the Subsequent Injury Fund?A: The Subsequent Injury Fund is a program that provides benefits to workers who have pre-existing disabilities that are aggravated by subsequent work-related injuries.

Q: Who can file a reimbursement request using Form DWC097?A: Employers who have paid benefits to an injured employee with pre-existing disabilities in Texas can file a reimbursement request using Form DWC097.

Q: What should be included in the Form DWC097?A: The Form DWC097 should include information about the injured employee, their pre-existing disabilities, the work-related injury, and the benefits paid by the employer.

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Form Details:

  • Released on January 1, 2021;
  • The latest edition provided by the Texas Department of Insurance - Division of Workers' Compensation;
  • 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 DWC097 by clicking the link below or browse more documents and templates provided by the Texas Department of Insurance - Division of Workers' Compensation.

Download Form DWC097 Subsequent Injury Fund Reimbursement Request Form - Multiple Employment - Texas

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