Get Tx Dwc042 2016-2025

The TX DWC042 form is essential for requesting workers' compensation death benefits in Texas. This guide will provide you with step-by-step instructions to help you accurately complete the form online, ensuring that you understand each required section.

Follow the steps to fill out the TX DWC042 effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Section A requires information about the employee who died. Fill in their full name, social security number (if known), address at the time of death, race/ethnicity, employer's name and address, supervisor's name, the cause of death (injury or disease), date of injury, and date of death. Additionally, provide a brief explanation of the injury and how it occurred, if known.
3. In Section B, provide details about the person filling out the form, including their full name and relationship to the deceased. Check the applicable boxes to indicate your connection and enter your social security number and date of birth.
4. If you are a non-dependent parent filling out the form, Section C asks whether the work injury took place between September 1, 2007, and August 31, 2009. Indicate your status regarding burial benefits by checking the relevant box.
5. Section D involves listing the names and details for each family member requesting death benefits. Include their full names, social security numbers, addresses, phone numbers, birth dates, and their relationship to the deceased. Indicate if they are under 17 or full-time students as applicable.
6. In Section E, if you know of anyone else who may be eligible for death benefits, provide their names, relationships to the person who died, and their contact information.
7. Finally, sign and date the form. Ensure all supporting documents, such as the death certificate and proof of relationships, are included before submission.
8. Once completed, you may save your changes, download, print, or share the form as needed.

Please complete your TX DWC042 form online to ensure a timely processing of your benefits.