Texas Workers' Compensation Notice 6 - Election of Workers' Compensation Mandatory

NOTICE TO EMPLOYEES CONCERNING	 	
WORKERS’ COMPENSATION IN TEXAS	
COVERAGE:	 [Name of employer] 	            	
has workers’ compensation insurance coverage from [name of commercial insurance comp\
any]  
       	 in the event of 	
work-related injury or occupational disease. This coverage is effective from [effective date of workers’ 
compensation insurance policy] 	  	. Any injuries or occupational diseases which occur on or after 	
that date will be handled by [name of commercial insurance company] 	       	
  	. An employee or a person acting on the employee’s behalf, 	
must notify the employer of an injury or occupational disease not later \
than the 30th day after the date 
on which the injury occurs or the date the employee knew or should have \
known of an occupational 
disease, unless the Texas Department of Insurance, Division of Workers’ Compensation (Division) 
determines that good cause existed for failure to provide timely notice.\
 Your employer is required 
to provide you with coverage information, in writing, when you are hired\
 or whenever the employer 
becomes, or ceases to be, covered by workers’ compensation insurance.
EMPLOYEE ASSISTANCE:	 The Division provides free information about how to file a workers’ 	
compensation claim. Division staff will answer any questions you may have about workers’ 
compensation and process any requests for dispute resolution of a claim.\
 You can obtain this assistance 
by contacting your local Division field office or by calling 1-800-252-7031.  The Office of Injured 
Employee Counsel (OIEC) also provides free assistance to injured employees and will explain your 
rights and responsibilities under the Workers’ Compensation Act. You can obtain OIEC’s assistance 
by contacting an OIEC customer service representative in your local Division field office or by calling 
1-866-EZE-OIEC (1-866-393-6432).
SAFETY VIOLATIONS HOTLINE:	 The Division has a 24 hour toll-free telephone number for 	
reporting unsafe conditions in the workplace that may violate occupation\
al health and safety laws. 
Employers are prohibited by law from suspending, terminating, or discrim\
inating against any employee 
because he or she in good faith reports an alleged occupational health o\
r safety violation. Contact the 
Division at 1-800-452-9595.
Notice 6 (01/13) TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS’ COMPENSATION  Rule 110.101(e)(1)

COVERED EMPLOYER
Texas Workers’ Compensation Rule 110.101(e)(1) requires employers who are covered by workers’ 
compensation through a commercial insurance company to advise their empl\
oyees that they do have 
workers’ compensation insurance coverage and to advise their employees of the Texas Department 
of Insurance, Division of Workers’ Compensation's toll free number to obtain additional information 
about their workers' compensation rights.
Notices in English, Spanish and any other language common to the employe\
r's emplo
must be posted and:1.
2.
3. 
 
 Prominently displayed in the employer's personnel office, if any;
Located about the workplace in such a way that each employee is likely t\
o see th
regular basis;
Printed with a title in at least 26 point bold type, subject in at least\
 18 point bold ty
at least 16 point normal type; and
4.	
 Contain the exact words as prescribed in Rule 110.101(e)(1).