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Texas Regional Office <br />THIS LETTER CONTAINS IMPORTANT INFORMATION. <br />450 Gears Road, Suite 500 <br />PLEASE READ CAREFULLY AND RETAIN THIS LETTER <br />Houston, TX 77067-4585 <br />P.O. Box 4611 <br />FOR FUTURE USE. <br />Houston, TX 77210-4611 <br />Telephone (281) 874-9600 <br />TO:WORKERS' COMPENSATION POLICYHOLDERS IN TEXAS <br />ThankyouforchoosingTheHartfordasyourworkers'compensationcarrier.Weaskthatyoutakeaminutetofamiliarize <br />yourself with the forms and reporting requirements for the State of Texas which we have included in this packet. <br />1.Eachemployershouldmaintainarecordofallinjuriesreportedormadeknowntotheemployer.TheTexas <br />Department of Insurance, Division of Workers’ Compensation (DWC) may at times request these records for review. <br />2.IftheinjurycausesanemployeetobeoffworkmorethanonedayORinvolveaclaimforanoccupationaldiseaseyou <br />must immediately report the loss. <br />3.Please refer to Form WC 66 02 51 for LossConnect loss reporting instructions. <br />4.LossConnect will file all necessary state reports. <br />5.THECLAIMMUSTBEREPORTEDNOLATERTHANTHEEIGHTHDAYAFTERTHELOSSOFONEDAYOF <br />WORKORTHEFIRSTNOTICEOFANOCCUPATIONALDISEASE.FAILURETOCOMPLYMAYRESULTINAN <br />ADMINISTRATIVE VIOLATION WHICH COULD INCLUDE UP TO A $500.00 FINE. <br />6.TheFROImustbefiledevenonadoubtfulordisputedclaim.Yourlackofknowledgeoftheclaimdetailsshouldbe <br />reflected on the report. <br />COMPLETIONOFAFROIISNOTCONSIDEREDANADMISSIONOFOREVIDENCEOFACOMPENSABLEINJURY <br />IF THE FACTS CONTAINED THEREIN ARE LATER CONTRADICTED. <br />7.TheEmployer'sWageStatement(DWC-3)shouldbeprovidedtothecarrier,employee,andDWCifyouknowor <br />expect 8 days of disability. <br />8.TheSupplementalReportofInjury(DWC-6)shouldbefiledwiththecarrierwheneveryou(astheemployer)are <br />aware of any change in work status or earnings due to the injury.DO NOT SEND TO THE DWC. <br />We,asthecarrier,cannotactquicklyandefficientlyinyourinterestunlessimmediatenoticeofaninjuryisreceived.Your <br />cooperation is imperative and we stand to assist you in any way we can. <br />The Hartford Insurance Group <br />Form WC 55 00 22 APrinted in U.S.A. <br />Hartford Fire Insurance Company and its Affiliates <br />Hartford Plaza, Hartford, Connecticut 06115 <br /> <br />