Texas Department of Insurance Worker Coverage Notices
This file contains important amendments related to employer notices regarding worker exposure to communicable diseases in Texas. It outlines updated reporting requirements, employee notifications, and agency contact information. Employees and employers must understand these provisions to ensure adherence to Texas workers' compensation laws.
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How do I fill this out?
To fill out this form, gather all necessary information regarding your employer’s coverage. Ensure you have updated contact details for the Division of Workers' Compensation. Follow the instructions carefully to complete the required sections.

How to fill out the Texas Department of Insurance Worker Coverage Notices?
1
Gather necessary documents and information.
2
Fill in the required sections accurately.
3
Double-check for any possible errors or omissions.
4
Submit the form as per the given instructions.
5
Keep a copy for your records.
Who needs the Texas Department of Insurance Worker Coverage Notices?
1
Employees needing to report exposure to diseases.
2
Employers to fulfill their legal obligations.
3
Contractors working on governmental projects.
4
Health officials for compliance checks.
5
Legal professionals advising clients on workers' compensation.
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What are the instructions for submitting this form?
Submit this form via email to the Division at workers@tdi.texas.gov or fax it to (512) 804-4000. You can also drop off the completed form at your local Division office. For any online submission, visit the official Texas Department of Insurance website for guidance. Always ensure to keep copies for your records.
What are the important dates for this form in 2024 and 2025?
The amendments to sections §110.108 and §110.110 will be effective throughout 2024, with continuing implications for compliance into 2025. Regular updates on contact information and employer obligations are essential for all users.

What is the purpose of this form?
The purpose of this form is to inform employees about their rights and the processes related to exposure to communicable diseases in the workplace. It ensures that employers notify employees about their coverage and any changes therein. Understanding the guidelines helps facilitate communication between employees and employers regarding health and safety matters.

Tell me about this form and its components and fields line-by-line.

- 1. Employee Notification Section: Details specific to employee notifications regarding exposure.
- 2. Employer Requirements: Outlines employer responsibilities for providing coverage.
- 3. Reporting Section: Guidelines for reporting incidents related to communicable diseases.
What happens if I fail to submit this form?
Failure to submit this form can result in non-compliance with Texas regulations, leading to potential penalties for employers. Employees may miss out on benefits and necessary support.
- Legal Consequences: Non-compliance may result in legal action against the employer.
- Health Risks: Employees could be unaware of exposure risks.
- Loss of Benefits: Employees may lose out on required support and coverage.
How do I know when to use this form?

- 1. Exposure Reporting: To report any exposure to communicable diseases.
- 2. Coverage Verification: To confirm employer compliance and coverage obligations.
- 3. Health Monitoring: To ensure continuous health safety in workplaces.
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