Get Tx Dwc031 2017-2025

The TX DWC031 form is an essential document for requesting approval for a change in payment period and/or the purchase of an annuity for death benefits within the Texas workers' compensation system. This guide will walk you through each section of the form, ensuring you can complete it accurately and efficiently.

Follow the steps to fill out the TX DWC031 online

1. Press the ‘Get Form’ button to access the TX DWC031 form and open it in your preferred online editor.
2. Begin by entering the employee's name in the designated field. Make sure the name is spelled correctly as it appears in official documents.
3. Next, input the date of injury in the specified format, ensuring clarity and accuracy for proper processing.
4. In the field for the insurance carrier's name, write the full legal name of the insurance carrier responsible for the claims.
5. Enter the employer's business name, which connects the claim to the correct employer.
6. Fill in the beneficiary's name, correctly identifying the individual entitled to receive the death benefits.
7. Check all applicable boxes concerning the desired changes: whether to change the payment period from weekly to monthly, or if the carrier will purchase an annuity.
8. If requesting a change in payment period, calculate and propose the monthly benefit by multiplying the weekly compensation rate by 4.34821.
9. Provide the name of the payor responsible for disbursing benefits, along with their mailing address, city, state, and zip code.
10. In the section designated for the signatures, ensure all required parties sign and date the form, including the representative of the beneficiary and the carrier representative.
11. Review all entered information for accuracy and completeness before proceeding.
12. Once satisfied with the form, proceed to save your changes, and then download, print, or share the completed TX DWC031 as needed.

Complete your TX DWC031 form online today to ensure timely processing of your application.