Texas Mutual Insurance Company - Providers of Workers' Comp Insurance

Forms & Sample Documents

Click on the links below to open a copy of the form or sample document. If you have any problem printing the forms, check our tips for downloading and printing forms.

Form Format
Electronic Funds Transfer Form PDF
Employee Notice of Ombudsman Services PDF
Notice of Injured Employee Rights and Responsibilities in the Texas Workers' Compensation System (English, Spanish, Chinese, Korean, Vietnamese) PDF
DWC-48, Request for Travel Reimbursement PDF
DWC-53, Employee's Request to Change Treating Doctor - Non Network PDF
DWC-53, Employee's Request to Change Treating Doctor - Non Network (Spanish) PDF

More forms on the Web

For more forms related to workers’ compensation insurance or general workplace issues, visit the appropriate agency’s website, listed below.


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