DWC Form-73, Texas Work Status Report: Filing and Disputes

The DWC Form-073, Texas Work Status Report, is filled out by the treating doctor after a workers’ compensation examination to document whether the injured employee can return to work, return with restrictions, or remain off the job entirely. It then goes to the insurance carrier, the employer, and the employee. You can download it from the Texas Department of Insurance, Division of Workers’ Compensation at tdi.texas.gov, or request a copy by calling DWC at 800-252-7031.¹ Injured employees do not complete this form, but you need to understand what it says because the boxes checked on it drive your modified-duty assignment and your income benefit payments.

When a New Report Must Be Filed

Texas Administrative Code Title 28, Section 129.5 lists the events that require the treating doctor, or a delegated physician assistant or advanced practice registered nurse, to complete a new Form-073.² A report is required:

After the first examination of the injured employee, whether or not the employee can currently work.
Whenever the employee’s work status changes or there is a substantial change in activity restrictions.
On a periodic schedule requested by the insurance carrier (or the employer through the carrier), but no more often than once every two weeks and only in connection with the doctor’s scheduled appointments with the employee.

A separate seven-day deadline kicks in when the doctor receives either a functional job description from the employer listing available modified-duty positions, or a required medical examination doctor’s Work Status Report indicating the employee can return to work. In those situations the treating doctor must file a new Form-073 within seven days, and no new physical exam is required to do so.²

How to Complete the Form

The form has four parts. Each one feeds a different decision downstream, so blanks and vague entries cause real problems.

Part I: Employee and Doctor Information

The top of the form asks for the injured employee’s name, date of injury, and the last four digits of the employee’s Social Security number, along with the doctor’s name, degree, license number, phone and fax numbers, and facility address.¹ If the date of injury does not match what the carrier has on file for the claim, the report can get routed to the wrong place or flagged for review.

Part II: Work Status

Field 13 is the heart of the form. The doctor checks one of three boxes:¹

Box 13a, full return with no restrictions, with the return-to-work date.
Box 13b, return with restrictions as of a specified date, with an expected end date for those restrictions and the details filled in under Part III.
Box 13c, unable to work, with an expected end date for the inability.

Each box requires specific dates. Those dates determine when temporary income benefits start, continue, or stop, so missing or imprecise dates create disputes later.

Part III: Physical Restrictions

Part III is only completed when box 13b is checked, and it is what employers use to decide whether they can offer modified duty. The categories are:¹

Field 14, posture restrictions, using time-based increments of 0, 2, 4, 6, or 8 hours per day for activities such as standing, walking, sitting, climbing stairs, kneeling, bending, pushing and pulling, reaching, overhead reaching, twisting, grasping, and keyboarding, plus sit-and-stretch break frequency.
Field 15, body-part specificity, identifying whether a restriction applies to a particular side or body part such as the left hand, right leg, neck, or back.
Field 16, environmental and other restrictions, covering overall work-hour limits and conditions like extreme heat or cold, working at heights or on scaffolding, or keeping a body part elevated, clean, and dry.
Field 17, motion restrictions, including splints or casts at work, crutch use, driving limits (with an “automatic transmission only” option), and skin-contact restrictions.
Field 18, lift and carry limits, giving the maximum weight the employee can lift or carry and for how many hours per day, or indicating no lifting at all.
Field 19, maximum work hours per day.
Field 20, medication restrictions, noting prescription or over-the-counter medication and any drowsiness that creates safety or driving concerns.

A form that only says “light duty” without pound limits or hour caps gives the employer no basis for building a modified position. Precise restrictions make a workable plan possible.

Part IV: Signature

The doctor signs, dates the form, and includes a license number. Without a valid signature, the form has no legal weight in the Texas workers’ compensation system.

How the Completed Form Is Distributed

The doctor must deliver the form to the insurance carrier and the employer no later than the end of the second working day after the examination.² According to the form’s FAQ, the carrier receives its copy by electronic transmission. The employer also receives it electronically, but if the employer has not provided a fax number or email address, the doctor sends it by personal delivery or mail. The injured employee receives the form by hand at the appointment, or electronically if the employee has agreed to that method.¹

If you receive the form at your appointment, get a copy to your employer as soon as possible. A delayed form can hold up a modified-duty offer or interrupt benefit payments.

How the Form Affects Your Income Benefits

The Work Status Report controls temporary income benefits. When box 13c is checked, the carrier continues paying benefits based on lost wages. When box 13b is checked, the employer may offer a modified-duty position that fits within the documented restrictions.³ A bona fide offer of employment must match the physical and time requirements listed on the Form-073. If the employee is released with restrictions and refuses a job that fits within those restrictions, the carrier can suspend income benefits based on the wages that were offered.⁴ If the offered wages equal or exceed the employee’s pre-injury average weekly wage, no temporary income benefits are owed.⁵

When box 13a is checked, temporary income benefits end as of the return-to-work date. An incorrect date on this line can trigger an overpayment or underpayment that takes months to untangle.

If You Disagree With the Work Status

If you believe the treating doctor’s determination is wrong, whether it clears you for duties you cannot physically perform or lists restrictions so broad they keep you from working at all, you have several options.

Letter of Clarification

Either party can ask DWC to send the designated doctor a letter of clarification when questions arise about the doctor’s report. The request must explain why clarification is needed to resolve a pending or future dispute, include non-leading questions, and provide any medical records the doctor did not already have.⁶ Fax the request to DWC at 512-804-4011. A benefit review officer or administrative law judge decides whether to approve or deny it.

Designated Doctor Examination

When there is a genuine dispute over the ability to return to work, either party can request a designated doctor examination. The request must include a specific reason for the exam, the current diagnosis, and the body parts affected. If the dispute involves return-to-work ability, include the beginning and ending dates for the period being evaluated. Submit the request to DWC on the prescribed form and send a copy to the other party.⁶

Benefit Review Conference

If informal steps do not resolve the disagreement, either party can request a benefit review conference by filing DWC Form-045. You need to show that the parties tried to resolve the dispute first, so include letters or emails documenting those efforts. Send the request and supporting documents to DWC by mail at PO Box 12050, Austin, TX 78711-2050 or by fax at 512-804-4011, with a copy to the other party. DWC staff then work with both sides to try to reach a resolution.⁷

Billing Codes for Providers

Doctors bill for the Work Status Report using CPT code 99080. The modifier depends on why the report was filed:²

Modifier 73 for a report filed after the initial exam, after a change in work status, or in response to a functional job description or required medical exam report.
Modifiers 73 and RR for an additional update requested by or through the insurance carrier.
Modifiers 73 and EC when the carrier requests an extra copy of a previously filed report.

A carrier-requested report billed without the RR modifier can be denied or flagged for correction, which delays reimbursement.

1
Texas Department of Insurance. Texas Workers’ Compensation Work Status Report
2
Legal Information Institute. 28 Texas Admin Code 129.5 – Work Status Reports
3
Legal Information Institute. 28 Texas Admin Code 129.6 – Bona Fide Offers of Employment
4
State Office of Risk Management. Bona Fide Offer of Employment
5
Legal Information Institute. 28 Texas Admin Code 129.2 – Entitlement to Temporary Income Benefits
6
Texas Department of Insurance. Injured Employee FAQ
7
Texas Department of Insurance. About Benefit Review Conferences (BRCs)