TX Workers' Compensation Commission
Showing 17–32 of 38 results
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Explanation of Benefits
TWCC-62 $89.00 -
Medical Dispute Resolution Request
TXWCMDRR $89.00 -
Medical Dispute Resolution Request
TWCC-60 $89.00 -
Non-Covered Employer’s Report of Occupational Injury
TWCC-7 $89.00 -
Notice of Fatal Injury or Occupational Disease/Claim for Compensation for Death Benefits
TWCC-42 $89.00 -
Notice of Intent to Suspend Temporary Income Benefits
TWCC-34 $89.00 -
Notice of Representation or Withdrawal of Representation
TWCC-150 $89.00 -
Notification of First Payment (Cover)
TWCC-26 $89.00 -
Notification Regarding Maximum Medical Improvement and/or Impairment Rating
TWCC-28 $89.00 -
Payment of Compensation or Notice of Refused or Disputed Claim
TWCC-21 $89.00 -
Recommendation for Spinal Surgery
TWCC-63 $89.00 -
Report of Medical Evaluation
TWCC-69 $89.00 -
Request for a Benefit Review Conference
TWCC-45 $89.00 -
Request for Copies of Confidential Claim/Hearing Files
TWCC-153 $89.00 -
Request for Extension of Maximum Medical Improvement for Spinal Surgery
TWCC-57 $89.00 -
Request for Prospective Review of Medical Care
TWCC-49 $89.00