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Quick answer: Fax DWC Form-041 (your claim) and DWC Form-042 (death benefits) to the Texas Division of Workers’ Compensation at 512-804-4378. Papers for a benefit review conference or a hearing go to a different fax, 512-804-4011, split into sections of under 40 pages, each with its own cover page. Keep the confirmation page: your DWC-041 has to be sent within one year.
In Texas, reporting a work injury to your employer and filing a claim with the state are two jobs with two deadlines. You have 30 days to tell your employer. Then you have one year from the injury, or from the day you knew or should have known it was work-related, to send your own DWC Form-041 to the Division of Workers’ Compensation (DWC).
Even if DWC already knows about the injury, send it. The letter DWC posts to injured employees once it has notice of an injury still tells them to send a DWC-041 within the year.
One fax for claims, others for disputes
Checked on the Texas Department of Insurance’s own pages on 16 October 2026.
| What you’re sending | Fax | Source | Checked on |
|---|---|---|---|
| Employee’s Claim for Compensation (DWC Form-041) | 512-804-4378 | TDI injured employee FAQ; printed on the form | 16 Oct 2026 |
| Claim for death benefits (DWC Form-042) | 512-804-4378 | TDI injured employee FAQ | 16 Oct 2026 |
| Employee Request to Change Treating Doctor (DWC Form-053) | 512-804-4378 | Printed on the form (Spanish edition, DWC-053S) | 16 Oct 2026 |
| Exchanges and hearing exhibits for a benefit review conference or contested case hearing | 512-804-4011 | TDI disputes FAQ | 16 Oct 2026 |
| An appeal, or a response to one | 512-804-4021 | TDI disputes FAQ | 16 Oct 2026 |
Filling in the DWC-041
The form’s own instruction is to complete every box, including these:
- Your employer at the time of the injury. Not where you work now, if you’ve moved on since.
- The date you left Texas, if the accident happened outside the state. The form asks for it.
- The signature box. Someone acting on your behalf can file the form, and they sign and print their own name there.
- A cover page with your name, date of injury and a phone number. DWC doesn’t require one, but it keeps a multi-page fax together; there’s a cover sheet generator for it.
Once DWC has the form, it opens a claim, gives it a DWC claim number and posts you information about workers’ compensation in Texas. That number goes on everything you send afterwards.
The same fax takes DWC Form-053, the Employee Request to Change Treating Doctor, if you’re not in a workers’ comp health care network. Get your new doctor to sign it first (box 27), to show they’ve agreed to treat you. DWC reviews the request within 10 days of receiving it.
Post the DWC-041 to the address printed on the form, or call DWC customer service on 800-252-7031 (option 1 for claims) for help filling it in. A DWC-042 can also go to the insurance carrier instead of DWC, or to DWC through its secure upload.
Against a one-year deadline, the dated confirmation page is the record you want: Municorn Fax sends the signed DWC-041 to 512-804-4378 from your phone and keeps one. From a computer or email inbox, EveryFax does the same, with a two-week trial.
Dispute papers: the 40-page rule
If your claim reaches a benefit review conference (BRC) or a contested case hearing, the documents you share go to 512-804-4011, not the claims fax. DWC’s instructions are specific: break them into sections of fewer than 40 pages, fax each section separately, and give every section a cover page showing the claim number and the section number.
Whatever you send DWC for a dispute also has to go to the other parties, and DWC encourages encrypted email for those copies. DWC’s own copy can go by email too: exchanges to BRC_Exchanges@tdi.texas.gov and hearing exhibits to CCH_Exhibits@tdi.texas.gov. Both use an underscore, not a hyphen.
Ohio BWC, the Oregon Workers’ Compensation Board and Washington L&I each have their own page.
Frequently Asked Questions
What’s the deadline for the DWC-041?
Send it within one year of the injury, or within one year of when you knew or should have known it was work-related. Separately, report the injury to your employer within 30 days.
DWC already wrote to me. Do I still need to send the 041?
Yes. DWC’s letter to injured employees says to send a DWC-041 within one year of the date you were hurt or first knew your illness was work-related.
Can someone else fax the form for me?
Yes. A person acting on your behalf can file it. They sign it and print their own name in the signature box.
Where do I fax a death benefits claim?
To 512-804-4378, the same fax as the 041. Beneficiaries have one year from the date of death, and can send the DWC-042 to DWC or to the insurance carrier.
Sources
- Texas Department of Insurance, injured employee FAQ: fax 512-804-4378, the 30-day and one-year rules, DWC-042. Checked 16 October 2026.
- DWC Form-041: who can file, the one-year rule, the instructions. Checked 16 October 2026.
- DWC Form-053S (Spanish edition of the change of treating doctor request): fax 512-804-4378, the 10-day review. The English form is DWC Form-053. Checked 16 October 2026.
- DWC letter to injured employees (CS-41). Checked 16 October 2026.
- TDI disputes FAQ: 512-804-4011, the 40-page sections, 512-804-4021. Checked 16 October 2026.
- TDI, sending information for dispute resolution: copies to other parties. Checked 16 October 2026.
