Get Compensation Work Status Report - Texas Department Of Insurance

This guide provides a step-by-step approach to completing the Compensation Work Status Report for the Texas Department of Insurance. It is designed to assist you in accurately filling out the necessary information to report your work-related injuries and assist your employer and insurance carrier.

Follow the steps to complete the report effectively.

1. Click ‘Get Form’ button to obtain the document and open it in the editor.
2. Begin by filling out Part I: General Information. Enter the injured employee's full name, Social Security number (last four digits), date of injury, and employer's name. Make sure that all information is accurate to prevent delays.
3. Provide the doctor's name and degree for communication purposes. Include their clinic or facility name, address, and contact information. If known, input your employer’s fax number or email address for ease of communication.
4. In Part II: Work Status Information, fill out the medical condition status. Specify whether the injured employee can return to work without restrictions, with restrictions, or cannot return to work at all. Indicate appropriate dates and detailed descriptions as necessary.
5. If applicable, complete Part III: Activity Restrictions. If the employee requires work restrictions, clearly note any limitations such as posture, motion, lifting, carrying, or medication restrictions and specify the periods involved.
6. In Part IV: Treatment/Follow-Up Appointment Information, provide the diagnosis details and expected follow-up services. Include evaluations, referrals, and any special studies as needed.
7. At the conclusion of the report, the employee and doctor must sign and date the document. This validation is crucial for the submission process.
8. Lastly, save your changes, and you can choose to download, print, or share the completed report as necessary.

Complete your Compensation Work Status Report online today for efficient processing.