Free Dwc 73 Form in PDF

Instructions on Writing Dwc 73

Filling out the DWC 73 form, also known as the Texas Workers’ Compensation Work Status Report, is a critical step for managing a workers' compensation claim in Texas. It helps communicate an injured employee's work ability to their employer and insurance carrier, based on their medical condition. Whether you're returning to work with no restrictions, with restrictions, or unable to return at all, this form serves as an official update on your status. Doctors, physician assistants, and advanced practice registered nurses use it to report your condition and any expected changes. Here's a step-by-step guide to help you understand how to fill it out correctly.

1. Fill in the Date Sent on the top of the form. This is for transmission purposes only.
2. Enter the Injured Employee's Name in the designated space provided.
3. Record the Date of Injury to specify when the injury occurred.
4. Provide the last four digits of the Social Security Number (SSN) of the injured employee.
5. Describe the injury or accident in the Employee’s Description of Injury/Accident section.
6. Fill out the Doctor’s/Delegating Doctor’s Name and Degree or the PA/APRN Name if they are completing the form.
7. Include the Facility Name, along with the Facility/Doctor Phone and Fax Numbers.
8. List the Facility/Doctor Address in full, including street, city, state, and ZIP code.
9. Provide the Employer's Name, and if known, the Employer’s Fax Number or Email Address.
10. Enter the Insurance Carrier information and, if available, the Carrier’s Fax Number or Email Address.
11. Under the WORK STATUS INFORMATION section, indicate the injured employee's medical condition by completely filling out one of the boxes (a, b, or c) and include estimated dates and a description if applicable.
12. If there are any ACTIVITY RESTRICTIONS, complete the relevant sections based on the restrictions identified. This includes posture, motion, miscellaneous restrictions, and any specific restrictions relevant to parts of the body or medication taken.
13. In the TREATMENT/FOLLOW-UP APPOINTMENT INFORMATION section, provide the Work Injury Diagnosis, Expected Follow-up Services, and any anticipated special studies or referrals.
14. Sign and date the form accordingly at the bottom.

After the DWC 73 form is filled out, it's ready to be delivered according to the instructions provided for its specific category of submitter. This could mean directly handing it to the employer, sending it electronically via email or fax, or through other specified means. Timely submission of this form plays an essential role in ensuring that the injured employee receives the appropriate medical care and benefits, and aids in a smooth transition back to work when possible.

What is DWC Form-073 and who needs to fill it out?

DWC Form-073, also known as the Texas Workers’ Compensation Work Status Report, is a form that doctors fill out after examining an employee who has suffered a work-related injury. It details the employee's work status, including any restrictions or the ability to return to work with or without limitations. Treating doctors, referral doctors, delegated physician assistants, and advanced practice registered nurses may need to complete it depending on the circumstances of the employee's work status and medical condition.

When am I required to file DWC Form-073?

The requirement to file DWC Form-073 varies. Treating doctors must file after the initial examination of the injured employee, referral doctors when there is a change in the injured employee’s work status, and delegated physician assistants if there’s a substantial change in activity restrictions or as requested by the insurance carrier. Advanced practice registered nurses must file after receiving job descriptions or a DWC Form-073 indicating that the employee can return to work with or without restrictions.

Where do I file DWC Form-073?

This form should be filed with the insurance carrier or employer. The filing can be done through electronic transmission, hand delivery, or mail if no fax number or email address has been provided by the recipient. The specific delivery method often depends on the doctor's filing and the agreement with the recipient.

What is the deadline for filing DWC Form-073?

Deadlines for filing DWC Form-073 depend on the specifics of the case. Generally, it should be filed within two working days of the doctor’s examination but can vary based on the type of doctor filing it and the requested schedules by the insurance carrier. It’s important to adhere closely to these deadlines to ensure the workers' compensation process moves forward smoothly.

What information does DWC Form-073 require?

The form requires detailed information including the injured employee's name, social security number, description of the injury/accident, medical condition, work status, any restrictions on activities or tasks they can perform, and any required treatment or follow-up appointments. It is a comprehensive report meant to communicate the employee's ability to return to work after an injury.

Are there any guidelines for completing the activity restrictions section?

In the activity restrictions section, only complete this part if there are specific limitations to the employee's ability to perform regular work duties. This includes posture, motion, misc. restrictions, specific restrictions relating to body parts, lift/carry restrictions, and medication restrictions. Be as detailed as possible, including maximum hours per day of work and specific limitations.

What should I do if I have questions about completing DWC Form-073?

If you have questions about completing the form, you can call Comp Connection for Health Care Providers at 1-800-372-7713 (or 512-804-4000 in the Austin area) and select option 3 for help. This line will provide detailed guidance on filling out and filing the form accurately.

Where can I find additional information about DWC Form-073 filing requirements?

For complete requirements regarding DWC Form-073, refer to 28 Texas Administrative Code §§126.6, 127.10, and 129.5. These rules are accessible on the TDI website under the workers’ compensation section. They provide comprehensive guidance on when and how to file the work status report.

What rights do employees have related to DWC Form-073?

Employees have the right to be informed about the information collected through DWC Form-073 and to review and correct any inaccuracies. This ensures transparency and correctness in the management of their work-related injury case.

Is DWC Form-073 available in other languages?

While the official document provided by the Texas Department of Insurance is in English, there may be resources available to assist employees and healthcare providers who speak other languages. It’s recommended to contact the Texas Department of Insurance for assistance in these cases.

One common mistake individuals make when filling out the DWC 73 form is incorrectly reporting the date of injury or the date sent. This is crucial as it establishes the timeline for the worker's compensation claim, and any inaccuracies here can delay the processing of benefits. The proper dates provide a clear timeline of events and ensure that the claim is considered within the applicable statute of limitations and reporting timeframes set by the Texas Department of Insurance, Division of Workers' Compensation (DWC).

Another area that is often filled out incorrectly involves the injured employee’s social security number. Providing only the last four digits is required, but mistakes or omissions can complicate identity verification processes and hinder communication between the healthcare provider, employer, and insurance carrier. This could lead to delays in receiving benefits or even result in the denial of the claim.

Failing to accurately describe the injury or accident is a significant oversight. The "Employee’s Description of Injury/Accident" section is critical for the DWC and insurance carriers to understand the nature and extent of the injuries sustained. Vague or incomplete descriptions can make it challenging to evaluate the claim properly, potentially affecting the determination of benefits.

When indicating the injured employee's work status, it's crucial to clearly specify whether the employee can return to work with or without restrictions or if the employee is unable to return to work as of a certain date. Inaccuracies or failing to complete one of the boxes fully, including estimated dates and a detailed description if applicable, can lead to misunderstandings about the employee’s capacity to work, impacting the support and accommodations provided by the employer.

Within the activity restrictions section, errors often occur when individuals do not specify or incorrectly specify posture and motion restrictions, lifting/carrying limitations, or other relevant restrictions. It’s imperative to detail these accurately to ensure the injured worker does not further harm themselves by performing tasks outside their capacity. Moreover, employers rely on this information to make necessary modifications or provide suitable duties aligned with the employee's capabilities.

Last but not least, providing incomplete or inaccurate treatment and follow-up appointment information can negatively impact the coordination of care and the claims process. It's essential to include expected follow-up services, evaluation by the treating doctor, and any special studies required. Missing or incorrect information could lead to a lack of necessary medical intervention and subsequently delay the injured employee's recovery process.

When handling workers' compensation claims in Texas, the DWC 73 form, known as the Texas Workers’ Compensation Work Status Report, serves as a fundamental document in reporting an injured employee's work status. This form, crucial for detailing an injured employee's capability to return to work—including any restrictions or the lack thereof—is often accompanied by several additional forms and documents. These additional documents play vital roles in ensuring a comprehensive approach to managing the claim and facilitating the employee's recovery and return to work process.

• DWC 74: This form is used to detail the Return to Work Guidelines for the injured employee. It outlines specific accommodations or modifications recommended to facilitate the employee's return to work, either on a modified duty, reduced hours, or a transitional basis.
• DWC 69: Also known as the Work Status Evaluation, this document is completed by the treating physician to certify an injured employee's ability or inability to return to work and may detail the extent of any permanent impairment.
• DWC 41: This is the Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease form. Injured employees use it to formally file a claim for workers' compensation benefits following an injury on the job.
• DWC 73A: This supplemental form to the DWC 73 may be used for providing additional treatment or work status details when the original DWC 73 form lacks sufficient space for a comprehensive overview.
• WC-PD-1: The Request for Paid Leave form allows employees to request the use of their accrued leave (e.g., sick leave, vacation) concurrent with receiving workers' compensation income benefits.
• DWC 15: This form, Request to Release Claim Information, permits the disclosure of confidential workers' compensation claim information to specified individuals or entities, ensuring that relevant parties have access to necessary data for processing the claim.
• DWC 22: The Work Status Report Verification by Employer form verifies the work status information provided by the healthcare provider. Employers use it to confirm the accommodations or restrictions for the injured employee as they return to work.

Each of these documents plays a crucial role in the workers' compensation claims process, providing structured ways to report, verify, and act upon the various aspects of an employee's injury and recovery journey. Whether it’s documenting the injury, detailing work status, or outlining recovery and return to work plans, these forms collectively enable a smoother, more coordinated approach to managing workers' compensation claims.

The DWC 73 form, a Texas Workers' Compensation Work Status Report, is essential in the workers' compensation process, providing a standardized method for communicating an injured employee's work ability. Similar to this are various other documents used within the workers' compensation and employment contexts to manage injury reports, work restrictions, and employee capabilities carefully. Each plays a role in ensuring that all parties involved—employers, employees, and insurers—have the necessary information to proceed with care and compliance.

One analogous document is the OSHA Form 300, which is a Log of Work-Related Injuries and Illnesses mandated by the Occupational Safety and Health Administration. Both DWC 73 and OSHA Form 300 serve to document workplace injuries but differ in their use; OSHA Form 300 is used for recording any workplace injury or illness requiring more than first aid, while DWC 73 specifically reports on an injured employee's work status and restrictions as related to a workers’ compensation claim.

The First Report of Injury or Illness (FROI) form, another key document, is filed with state workers' compensation boards and insurance companies to initially report a workplace injury or illness. Similar to the DWC 73, the FROI initiates the workers' compensation process but focuses on the initial notification and details of the injury or illness, rather than providing an ongoing status report on the employee's ability to work and any restrictions they may have.

The Return-to-Work (RTW) Program documentation, often developed by employers, outlines the procedures for reintegrating injured employees back into the workforce. Like the DWC 73 form, which may indicate an employee's ability to return to work with or without restrictions, RTW programs are designed to accommodate employees' restrictions and ensure a safe and efficient return to work. RTW documentation and DWC 73 together facilitate the injured employee's transition back to productivity.

The Medical Release to Return to Work form is a document typically provided by a healthcare provider, which clears an injured employee to return to work following a workplace injury. This document often complements the DWC 73 form by offering a medical opinion on the employee’s readiness to resume work, potentially with or without restrictions, relevant to their injury.

Another related document is the Job Description form that outlines the duties and physical requirements of a position. Employers might use this in conjunction with the DWC 73 form to determine if an injured employee can return to their original position or if adjustments and accommodations need to be made based on the employee's reported work status and restrictions.

The Employee’s Claim for Compensation for a Work-Related Injury or Occupational Disease (DWC Form-041) is filed with the Texas Department of Insurance, Division of Workers’ Compensation to officially claim workers’ compensation benefits. While it serves a different purpose, it connects to DWC 73 as part of the broader process of managing and compensating for work-related injuries, detailing the injury and claiming benefits as opposed to reporting work status.

The Notice of Ability to Return to Work form, used in some jurisdictions, ensures that both the employer and the employee are informed about the employee’s capacity to return to work following an injury, based on medical evaluations. It serves a similar purpose to the DWC 73 by facilitating communication about an employee's ability to return to work, albeit from a slightly different angle, focusing on notifications post-medical evaluation.

The Functional Capacity Evaluation (FCE) is a comprehensive battery of performance-based tests that are used to determine the ability of an employee to perform the physical aspects of their job. While not a document per se, the outcomes of an FCE would significantly inform the content of a DWC 73 form, particularly regarding the specific work restrictions or capabilities of an injured employee.

Together, these documents and evaluations create a comprehensive picture of an injured worker's journey—from the occurrence of the injury through the process of recovery and eventual return to work. Each plays a critical role in navigating the complexities of workers’ compensation and ensuring the injured employee receives the appropriate support and accommodations.

When completing the DWC 73 form, it's important to recognize its significance in the workers' compensation process. The form assists in documenting an injured employee's work status, a critical step in securing appropriate medical and income benefits. Accordingly, meticulous attention to detail and adherence to guidelines can streamline the process, ensuring the injured party receives their entitled support. Below are listed crucial dos and don’ts to consider:

• Do report your injury to your employer within 30 days if they have workers' compensation insurance. This initial step is pivotal for validating your claim.
• Do seek free assistance from the Texas Department of Insurance, Division of Workers’ Compensation (DWC), by calling 800-252-7031. Guidance from experts can significantly aid in navigating the complexities of your claim.
• Do meticulously check that every section of the DWC 73 form is completed. An accurately filled form is paramount to avoiding unnecessary delays.
• Do describe the injury/accident with as much detail and clarity as possible. A comprehensive depiction can substantially influence the assessment of the case.
• Do ensure that the medical condition and work status information align with the doctor's evaluation and recommendations. Consistency in reporting is crucial for clarity.
• Do include clear details about any activity restrictions as advised by the medical provider. This information is crucial for determining suitable work accommodations.
• Do review the form for any errors or omissions before submission. Ensuring the accuracy of filled-out information facilitates a smoother process.

• Don't delay reporting your injury. Not adhering to the 30-day reporting deadline can jeopardize your benefits.
• Don't attempt to complete or guess the medical sections of the form. These areas should strictly be filled by a certified health care provider.
• Don't overlook the importance of specifying any and all restrictions. Omitting details can result in inappropriate work assignments that could aggravate the injury.
• Don't submit the form without the required signatures. Signatures validate the authenticity and agreement of the documented information.
• Don't forget to keep a copy for your records. Having a personal record is vital for future reference or in case of disputes.
• Don't hesitate to consult DWC if there are any confusions or questions. Accessing available resources can provide clarity and direction.
• Don't ignore follow-up care or additional medical evaluations as indicated. Consistent medical evaluation is key to a successful recovery and claim process.

When discussing the DWC 73 form, specifically within the context of Texas Workers' Compensation, numerous misconceptions arise. Rectifying these misunderstandings is essential for both employers and employees to navigate their rights and responsibilities properly. Here are eight common misconceptions about the DWC 73 form:

• The DWC 73 form is only for the use of employees. This assumption is incorrect because the form is used by doctors to report an employee's work status to the employer and insurance carrier, based on medical findings.
• Any doctor can complete the DWC 73 form. In practice, only the treating doctor, referral doctor, delegated physician assistant, and advanced practice registered nurse with specific knowledge of the patient's condition should fill it out.
• The form is optional. Contrary to this belief, filing the DWC 73 form is a requirement after initial examination and when there are changes in the injured employee’s work status or activity restrictions.
• The form must be physically delivered. Although physical delivery is an option, the form can also be sent via electronic transmission, fax, or email, depending on the recipient's preferences and agreements in place.
• Filing deadlines for the DWC 73 are flexible. Deadlines are actually quite strict, generally within 2 working days or 7 days of an examination, to ensure timely communication of an employee's work status.
• Employees do not need to retain a copy. It is in the best interest of the injured employee to keep a copy for their records to maintain a personal history of the injury, work status reports, and potential changes over time.
• The form only concerns physical work restrictions. While the form addresses physical restrictions, it also covers other modifications, such as changes in duties, hours of work, and necessary accommodations due to medication side effects.
• The DWC 73 is the final step in reporting an injury. Actually, this form is part of ongoing communication. It might need to be filed multiple times as the employee's condition and ability to work changes over time.

Understanding these aspects of the DWC 73 form is vital for all parties involved in workers' compensation claims in Texas. Ensuring accurate and timely completion helps facilitate the injured employee's return to work, when possible, and supports their recovery process.

Filling out and properly using the DWC 73 form, officially known as the Texas Workers’ Compensation Work Status Report, is a critical duty for individuals navigating the aftermath of a workplace injury. Here are nine key takeaways to ensure its effectiveness and compliance.

• Timely Reporting: Employees must report their injury to their employer within 30 days if the employer has workers’ compensation insurance. This initial step is crucial for the processing of any benefits and assistance.
• Access to Assistance: Individuals have the right to free assistance from the Texas Department of Insurance, Division of Workers’ Compensation (DWC) for understanding their benefits and the claim process.
• Medical and Income Benefits: Filing the DWC 73 form can lead to entitlement to certain medical and income benefits, crucial for recovery and financial stability post-injury.
• Doctor’s Input is Required: The form must include the doctor’s (or delegating doctor’s) name, degree, and assessment of the employee’s work status, including any restrictions.
• Complete Work Status Information: A clear status update on the employee’s ability to return to work, including any restrictions or conditions, is essential for determining the benefits and accommodations needed.
• Itemize Restrictions: If applicable, specific details about activity restrictions such as posture limits, lifting/carrying limitations, and medication effects must be outlined to ensure the safety and well-being of the employee upon return.
• Follow-Up Treatment: The form requests detailed information on follow-up treatments or services, including evaluations and physical medicine, setting a clear path for recovery.
• Comprehensive Communication: The form must be delivered timely to the injured employee, the employer, and the insurance carrier, depending on the doctor completing the form. This ensures that all parties involved are informed and can act accordingly.
• Understand Filing Requirements: The specifics concerning when and where to file the DWC 73, along with the deadline and delivery method, vary depending on the type of doctor filing the report. Familiarizing oneself with these details guarantees compliance.

In summary, accurately completing and submitting the DWC 73 form is an instrumental process in the workers’ compensation claim. It not only facilitates the determination and delivery of rightful benefits to the injured employee but also orchestrates the steps necessary for a comprehensive and safe return to work.