Workers' Compensation Toolkit

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This kit is provided to new workers' compensation policyholders and their agents, as well as to all current policyholders when their policies renew. It contains important claims department contact information, instructions, and forms.


Texas Contact Information:

Nationwide Insurance - West Office
One Nationwide Gateway, Dept. 5574
Des Moines, IA 50391-5574
(800) 532-1212
Fax: (800) 562-4339

Agribusiness Mailing Address for Claims Related Mail
1100 Locust St., Dept 3010
Des Moines, IA, 50391-3010
Phone: (800) 228-6700
Fax: (800) 842-1482

 

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Texas Compliance Information

Posting Requirements

Reporting Of Claim By Employer

Penalties for Late Reporting

Physician Selection


Posters and Publications

For Employers who do not have coverage (must be posted for employees to read, for use on or after 1/1/13) Required


Notice to Employees Concerning Workers' Compensation in Texas (must be posted for employees to read, for use on or after 1/1/13) Required

Notice to Employees Concerning Workers' Compensation in Texas (must be posted for employees to read, for use on or after 1/1/13) (Spanish) Required

Notice - Employee Notice Ombudsman Program Required

Notice - Employee Notice Ombudsman Program (Spanish) Required

Notice of Injured Employee Rights and Responsibilities in the Texas Workers' Compensation System Required

Notice of Injured Employee Rights and Responsibilities in the Texas Workers' Compensation System (Spanish) Required

Injured Employee Rights and Responsibilities Required

Injured Employee Rights and Responsibilities (Spanish) Required

New Employee Notice (covered and non-covered employers shall notify their employees of coverage status, in writing, for use on or after 1/1/13)

New Employee Notice(covered and non-covered employers shall notify their employees of coverage status, in writing, for use on or after 1/1/13) (Spanish)


Forms

Employer's First Report of Injury or Illness


Employer's First Report of Injury or Illness (for state employees)

Employer's Wage Statement

Employer's Wage Statement (Spanish)

Employer's Multiple Employment Wage Statement

Employer's Multiple Employment Wage Statement (Spanish)

Employer's Wage Statement for School Districts

Employer's Wage Statement for School Districts (Spanish)

Supplemental Report of Injury Required

Employer's Report of Non-covered Employee's Occupational Injury or Disease

Program Review Report

Employer's Report for Reimbursement of Voluntary Payment






Please Note: The information on this site is maintained by a third-party, Nationwide does NOT warrant or represent that the information will be error-free. Your use of the site is on an as-is basis, at your sole discretion and risk. The site is for informational purposes, and nothing included in the site shall replace the need for qualified legal counsel. We recommend that you consult with legal counsel, agents, or risk managers regarding workers' compensation obligations.

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