Austin, TX – The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) has finalized revisions to DWC Form-067, Designated Doctor Certification Application.
Revisions to DWC Form-067 include minor updates to the applicant information, disclosure questions, and applicant authorization, attestation, and release sections for compliance and clarity. The revised form minimizes the use of an applicant’s social security number for tracking purposes by using the applicant’s medical license number instead. Revisions also include global form changes for consistency with other division forms.
An informal working draft of DWC Form-067 was posted on the TDI-DWC website on June 15, 2016, with an informal comment period ending on June 29, 2016. The finalized DWC Form-067 is available on the TDI-DWC website and is effective September 1, 2016.
Designated doctors may continue to use the existing DWC Form-067 until sixty days after the effective date of revised DWC Form-067.