New DWC Form-154, Workers’ Compensation Complaint Form

The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) has finalized new DWC Form-154,
Workers’ Compensation Complaint Form.
Title 28 Texas Administrative Code §180.2(a) states that any person may submit a complaint to TDI-DWC for alleged administrative
violations. Labor Code §402.023(c) states, in part, that TDI-DWC shall develop and post on its website a simple, standardized
form for filing complaints. New DWC-Form-154 provides a simple, standardized form for the filing of workers’ compensation
complaints and may be submitted via email, fax, or mail. A person may also submit a complaint without using the form through
TDI-DWC’s website, email, fax, written correspondence, or in person.
An informal draft of DWC Form-154 was posted on the TDI-DWC website on December 11, 2015, with an informal comment
period ending on January 4, 2016. The finalized DWC Form-154 is available in English and Spanish on the TDI-DWC website at
http://www.tdi.texas.gov/forms/form20numeric.html, and is effective March 1, 2016.
New DWC Form-154, Workers’ Compensation Complaint Form