Texas DWC: Fax Number for Form-041 Claims

What is the Texas DWC fax number for a workers' comp claim?

Texas DWC lists 512-804-4378 on its official Form-041 for work-related injury or occupational disease claims. The injured employee or someone acting on their behalf can submit it. The same fax also appears in the instructions for Form-042, the separate death-benefits claim form.

Where to fax

• Form-041, Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease: 512-804-4378. Source: the official Form-041.
• Form-042, Claim for Workers' Compensation Death Benefits, when submitting to DWC: 512-804-4378. Source: the official Form-042.
• Letter of Clarification requests about a designated doctor's report: 512-804-4011. Source: the official Injured Employee FAQ.

^{Fax numbers verified October 19, 2026.}

Which route should I use?

1. For a work-related injury or occupational disease claim, use Form-041 and fax it to 512-804-4378.
2. For a death-benefits claim, use Form-042 and follow its supporting-document instructions. If you're sending it to DWC, use the same 512-804-4378 fax.
3. For another DWC form or request, check that document's submission instructions. Letter of Clarification requests use 512-804-4011.

Before you fax Form-041

Complete every field requested by the form. Use the employer you worked for when the injury happened, and include your treating doctor's details if you have one. The injured employee or the person completing the form on their behalf must sign, date, and print their own name in the signature section.

If you're unsure how to complete a field, call DWC at 800-252-7031 for help. Keep a copy of the completed form and your fax transmission report.

What happens after you send it?

DWC's Form-041 instructions explain that it creates a claim and assigns a DWC claim number after receiving your completed form or another notice of the injury. DWC also mails you information about the workers' compensation process.

To check that DWC received your Form-041, its Injured Employee FAQ suggests calling after one to two weeks. Contact Claims & Customer Services at 800-252-7031, option 1. A fax transmission report records the send; it doesn't mean your benefits have been approved.

Need a different state's workers' comp fax number? See sending a fax to the Ohio BWC or check Washington L&I's fax number for existing-claim documents.