Get Tx Dwc153 2021-2026

The TX DWC153 form is a request for record check or copies of confidential claim information related to workers' compensation claims in Texas. This guide provides clear steps to help users complete the form accurately and efficiently, ensuring that all required information is included for submission.

Follow the steps to fill out the TX DWC153 online.

1. Click the ‘Get Form’ button to obtain the TX DWC153 form and open it in the online editor.
2. In Section I, provide the injured employee information. Fill out the required fields: the DWC claim number, employee's Social Security number, full name (first, middle, last), date of birth (mm-dd-yyyy), date of injury (mm-dd-yyyy), and the employee's address including street, city, state, and ZIP code.
3. Proceed to Section II to enter the requestor information. Include the name (first, middle, last), DWC representative box number (if applicable), position or title (if applicable), firm name (if applicable), complete address, email address, phone number, and fax number.
4. In Section III, indicate the information requested by checking the appropriate box for either a record check or copies of confidential claim information. Complete any fields that apply, such as the tracking number for copies of medical fee dispute resolution files, and select the format in which you wish to receive the documents.
5. In Section IV, indicate your eligibility to request the information by checking the box that applies to your situation. If necessary, attach documentation to support your request.
6. Sign and print your name in the designated fields in Section IV, and include the date of signature.
7. After completing all sections, review the form to ensure all required fields are filled out accurately. Once confirmed, you can save any changes, download a copy, print the form, or share it as needed.

Complete your TX DWC153 document online today to ensure timely processing of your request.