DWC Announces Draft New and Revised Forms

On May 31, 2024 DWC announced it was accepting public comments on the draft new and revised forms below.

These are not comments on the rules under the Administrative Procedure Act, but DWC will consider substantive comments before finalizing these forms.

The draft revised forms are as follows:

• • • DWC Form-032, Request for Designated Doctor Examination.
    • DWC PLN-04, Notice of Eligibility for Lifetime Income Benefits.
    • DWC PLN-07, Notice of Change of Indemnity Benefit Type.

The draft new forms are as follows:

• • • DWC Form-038, Application for Lifetime Income Benefits.
    • DWC Form-039, First Responder’s Annual Certification for Lifetime Income Benefits.

Drafts have been posted to the DWC website, and can be located at:
https://www.tdi.texas.gov/wc/rules/2024rules.html.

Stakeholders may submit comments on the draft forms by completing DWC’s online form, located at https://forms.office.com/g/6TrngaF4SV.