Get M4-06-7024f&dr.doc - Tdi Texas

This guide provides clear, step-by-step instructions for effectively completing the M4-06-7024f&dr.doc form from the Texas Department of Insurance. Whether you are familiar with these types of documents or new to the process, this guide aims to support you in navigating this essential form.

Follow the steps to complete the form accurately.

1. Click the ‘Get Form’ button to access the M4-06-7024f&dr.doc. This will allow you to open the form in your preferred online editing tool.
2. Begin by entering the requestor’s name and address in the designated fields. Ensure that all information is accurate and up to date.
3. Complete the MFDR Tracking # section with the specific tracking number: M4-06-7024-01. This number is essential for identifying your submission.
4. Fill in the DWC Claim # field with the relevant claim number associated with your case.
5. Input the injured employee's name in the corresponding section. Make sure you spell their name correctly to avoid any processing delays.
6. Provide the respondent's name and box number as required. Verify the details to ensure they align with your documentation.
7. Indicate the date of injury in the designated field using the correct format (MM/DD/YYYY).
8. Enter the employer’s name in the respective section. This information links the case to the relevant employer.
9. Fill in the insurance carrier number accurately; this information is crucial for the processing of claims.
10. Complete the sections for the requestor's and respondent's position summaries, ensuring that you attach any necessary principle documentation, such as the EOB and claim files.
11. Review all completed sections for accuracy and clarity. Make any necessary corrections.
12. Once all fields are filled out correctly, save your changes. You may also download, print, or share the completed form as needed.

Complete your documents online today for a smoother filing experience.