dwc form 041 online
DTIC S JAN 2 49 I 89 1 23 060
Nov 7, 1988 This document has been approved for public release and sale; its distribution is unlimited. Destroy this report when it is no longer needed.
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Texas Department Of Insurance
Complete all boxes in the DWC Form-041. If you have questions about completing this form, please call your local Division Field Office at 1-800-252-7031.
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Employees Claim for Compensation for a Work-Related Injury
Upon receipt of your completed DWC Form-041, or other notice of your injury, the Division will create a claim and establish a DWC claim number for you, and
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