Tdi texas gov forms form20employee html 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the REQUEST SPECIFICATIONS section. Check the appropriate box to indicate the type of medical contested case hearing you are requesting, and attach any necessary documents, such as a copy of the IRO decision if applicable.
3. In the INJURED EMPLOYEE CLAIM INFORMATION section, provide detailed information about the injured employee, including their name, physical address, social security number (optional), date of injury, insurance carrier's name, and employer's business details.
4. Move on to the REQUESTER INFORMATION section. Indicate your role (e.g., injured employee, health care provider) and provide your mailing address, printed name/title, phone number, signature, and date.
5. Review all entered information for accuracy before submitting. Ensure that all required fields are completed to avoid delays in processing your request.

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