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Gather worker's pay records including daily timesheets showing hours worked each day. These records will help you complete this section.Insurance Services Admin. TDI Form NumberDescriptionFile FormatLanguageDWC003Employer's wage statement. Rev. Workers' compensation benefits do not include damages for pain and suffering or punitive damages. Report the injury or illness to your employer. A modified position with the same employer. How do I file a claim? The insurer helps the employer develop transitional work and request reimbursement for its costs. What makes an employer eligible?