Texas Division of Workers' Compensation forms doctors complete, from the DWC073 work status report to MMI certification, designated doctor exams and IRO review.
The Texas Department of Insurance, Division of Workers' Compensation (DWC), sets the forms doctors use on Texas claims. The one you file most is the Work Status Report (DWC073), often called DWC Form-073. It is required after the initial exam, whenever work status or restrictions change, and when the carrier asks. Certifying doctors use the Report of Medical Evaluation (DWC069) for maximum medical improvement and impairment ratings, and designated doctors add the DWC068 when DWC orders an exam on extent of injury or disability.
Give the DWC073 to the injured employee at the visit and send it to the carrier within 2 working days of the exam. A delegated PA or APRN can complete it. The DWC069 is due within 7 working days of the exam with a narrative report, and only DWC-certified doctors may assign an impairment rating above zero. The DWC073 and the LHL009 IRO request have Spanish versions. Vero Documents fills these PDF forms from the visit note and the chart, and the doctor reviews and signs.
Reporte de Estado de Trabajo
Reports whether the injured employee can return to work without restrictions, with listed activity restrictions, or not at all, and the expected dates.
Certifies whether the injured employee has reached clinical or statutory maximum medical improvement (MMI) and assigns any permanent impairment rating.
Asks DWC for an interlocutory order so a denied, previously prescribed non-formulary drug can continue while independent review is pending.
Records a designated doctor's findings on extent of injury, disability, return to work and other issues other than MMI/impairment that DWC ordered the exam to address.
Solicitud para una revisión por parte de una Organización de Revisión Independiente
Requests independent medical-necessity review after a carrier or URA denies preauthorization or payment for health care services, including workers' compensation.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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After the initial exam, whenever the injured employee's work status or restrictions change, and when the insurance carrier asks, up to once every two weeks. It is also due after you receive functional job descriptions. Give it to the employee at the visit and send it to the carrier, and to the employer if you know a fax number or email, within 2 working days of the exam.
The treating doctor, a referral doctor, or a PA or APRN the doctor has delegated. Designated doctors and required medical examination doctors also complete it when they address work status. The form states whether the employee can return to work without restrictions, can return with listed activity restrictions, or cannot work yet, with expected dates. A Spanish version, DWC073s, is on the same DWC page.
A certifying doctor: the treating doctor, a doctor the treating doctor selects, a DWC designated doctor, or a DWC-approved carrier-selected RME doctor. Only DWC-certified doctors may assign an impairment rating above zero. When someone other than the treating doctor certifies, the treating doctor marks agreement or disagreement in Part V. File it within 7 working days of the exam with a narrative report.
Yes. The requesting health care provider may file the LHL009, Request for a Review by an Independent Review Organization, after a carrier or URA denies preauthorization or payment. Return it to the carrier or URA that denied the service, within 45 days for workers' comp. It costs the patient nothing, but in non-network retrospective reviews the provider pays the IRO fee up front and is reimbursed if the provider prevails.