Workers’ Compensation Forms and Resources

Forms

Notice to Healthcare Providers of Workers’ Compensation Insurance Coverage

Notice of Injured Employee Rights & Responsibilities in the Texas Workers’ Compensation System

Request for Paid Leave

Wage Statement

Supplemental Report of Injury

Student/Visitor Incident Report

Your health care provider, emergency room, or pharmacy may request billing information regarding your workers’ compensation claim. For these purposes, provide the following information to your treating physician or pharmacist:

Texas A&M System, Office of Risk Management
301 Tarrow Street, 5th Floor
College Station, TX 77840-7896
Phone: 866-249-8574; 979-458-6330
Fax: 979-458-6247

 Note: Supervisors note that absences due to work-related injuries may also fall under the provisions of The Family and Medical Leave Act (FMLA). Proper FMLA procedures must be followed.