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THElf <br /> HAR.TFORD <br /> THIS LETTER CONTAINS IMPORTANT INFORMATION, Texas Regional Office <br /> 450 Gears Road,Suite 500 <br /> PLEASE READ CAREFULLY AND RETAIN THIS LETTER Houston,TX 77067-4585 <br /> FOR FUTURE USE. P.O.Box 4611 <br /> Houston,TX 77210-4511 <br /> Telephone(281)874-9600 <br /> TO: WORKERS' COMPENSATION POLICYHOLDERS IN TEXAS <br /> Thank you for choosing The Hartford as your workers' compensation carrier. We ask that you take a minute to familiarize <br /> yourself with the forms and reporting requirements for the State of Texas which we have included in this packet. <br /> 1. Each employer should maintain a record of all injuries reported or made known to the employer. The Texas <br /> Department of Insurance, Division of Workers' Compensation (DWC) may at times request these records for review. <br /> 2. If the injury causes an employee to be off work more than one day OR involve a claim for an occupational disease you <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. THE CLAIM MUST BE REPORTED NO LATER THAN THE EIGHTH DAY AFTER THE LOSS. OF ONE DAY OF <br /> WORK OR THE FIRST NOTICE OF AN OCCUPATIONAL DISEASE. FAILURE TO COMPLY MAY RESULT IN AN <br /> ADMINISTRATIVE VIOLATION WHICH COULD INCLUDE UP TO A$500.00 FINE. <br /> 6. The FROI must be filed even on a doubtful or disputed claim. Your lack of knowledge of the claim details should be <br /> reflected on the report. <br /> COMPLETION OF A FROI IS NOT CONSIDERED AN ADMISSION OF OR EVIDENCE OF A COMPENSARLE INJURY <br /> IF THE FACTS CONTAINED THEREIN ARE LATER CONTRADICTED. <br /> 7. The Employer's Wage Statement (DWC-3) should be provided to the carrier, employee, and DWC if you know or <br /> expect 8 days of disability. <br /> 8. The Supplemental Report of Injury (DWC-6) should be filed with the carrier whenever you (as the employer) are <br /> aware of any change in work status or earnings due to the injury. DO NOT SEND TO THE DWC. <br /> We, as the carrier, cannot act quickly and efficiently in your interest unless immediate notice of an injury is received. Your <br /> cooperation is imperative and we stand to assist you in any way we can. <br /> Form WC 55 00 22 A Printed in U.S.A. The Hartford Insurance Group <br /> Hartford Fire Insurance Company and its Affiliates <br /> Hartford Plaza,Hartford,Connecticut 06115 <br />