Get Tx Dwc053 2008
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the TX DWC053 online
The TX DWC053 form, known as the employee's request to change treating doctor for non-network, is essential for injured employees wishing to change their medical provider. This guide outlines clear steps to complete the form online, ensuring the process is straightforward and accessible.
Follow the steps to complete the TX DWC053 form online.
- Click 'Get Form' button to obtain the form and open it in the editor.
- Fill in the employee information section, including your name, social security number, mailing address, telephone number, and date of injury.
- Provide the employer's information by entering the employer's name, telephone number, and mailing address.
- Enter the insurance carrier's information, including the carrier's name and the adjustor's name and phone number.
- Specify the treating doctor from whom you wish to change in the 'Request Change From' section.
- Complete the requester information, including the new doctor's name and title, mailing address, telephone number, and professional license number.
- Provide a reason for the change in the designated field and attach any necessary additional sheets.
- Ensure the new treating doctor signs the form and includes the date.
- Sign and date the form in the employee's signature section to authorize the change and release of medical records.
- Once completed, save changes to the form, download, print, or share it as necessary. Ensure that the form is sent to the field office handling your claim.
Complete your TX DWC053 form online today to initiate your request for a change of treating doctor.
Get form
To obtain Texas workers' compensation, you must report your injury to your employer and ensure they file a DWC 1 form. Following this, you should complete any required DWC forms like the DWC 053 to process your claim smoothly. It's vital to follow up on your claim status and provide any necessary documentation. If you need assistance, US Legal Forms can provide you with resources and forms needed to navigate this process successfully.
Get This Form Now!
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.