Get Supplemental Report Of Injury, Dwc Form-006 - Texas ... - Tdi Texas

Filling out the SUPPLEMENTAL REPORT OF INJURY, DWC Form-006, is a crucial step for both employers and injured workers in Texas to report changes in work status and earnings post-injury. This guide will provide clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete your supplemental injury report.

1. Press the ‘Get Form’ button to obtain the form and open it in your designated editor.
2. Fill in the employer information section including the employer’s business name, phone number, mailing address, and insurance carrier name.
3. Indicate whether the employer has return to work (RTW) opportunities available and provide contact information if applicable. Additionally, answer questions regarding RTW coordination and accident prevention services provided in the past 12 months.
4. In the reason for filing section, select the appropriate reason for submitting the report and note the deadlines for each scenario.
5. Complete the injured worker information section, including their name, last four digits of their social security number, date of injury, address, and phone number.
6. Fill in details about the injured worker’s employment status, including the first day of lost time or reduced wages and any additional lost time.
7. Answer questions related to the duration of lost time, resignation or termination, and provide the date of the most recent return to work.
8. Document the hours worked during the pay period and the earnings expected for that period, comparing them to the pre-injury wage.
9. Sign and date the form, certifying the information provided is accurate.
10. Finally, save the completed form. You may download, print, or share the document as necessary.

Complete your SUPPLEMENTAL REPORT OF INJURY online today to ensure accurate reporting and timely benefits.