DWC Form-042 is the Texas form that surviving family members use to ask for workers’ compensation death benefits. It is filed by the surviving family or beneficiary of a worker who died from a work injury. Losing someone is hard enough. Paperwork should not add to the weight. This guide explains what the form does, who files it, when, and where it goes. It uses plain words and short steps.
What the DWC Form-042 Is For
Texas workers’ comp can pay benefits to a family after a worker dies from a job injury. However, the benefits do not start on their own. A survivor has to make a formal claim. DWC Form-042 is that claim. It tells the state who died, how the death relates to work, and who is asking for benefits.
In most cases, the form also helps the state sort out who qualifies. For example, a spouse, children, or other dependents may each have a claim. Each person asking for benefits generally needs their claim on file. The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) runs this process. You can learn more about the agency on our Texas workers comp board page.
| Item | Details |
|---|---|
| Form number | DWC Form-042 |
| Form title | Claim for Workers’ Compensation Death Benefits |
| Who files | The surviving family or beneficiary of a worker who died from a work injury |
| Where filed | Texas Department of Insurance, Division of Workers’ Compensation |
| Fee | No filing fee is shown on the form. Confirm with TDI-DWC. |
| Official PDF | DWC Form-042 (PDF) |
Who Files the DWC Form-042 and When
The person who files DWC Form-042 is a survivor of the worker. That is usually a spouse, a child, or someone who depended on the worker’s income. In some cases, a guardian files for a minor child. Each beneficiary should check whether they need to file their own claim. Typically, the form asks how you are related to the worker. It also asks whether you depended on the worker for support.
Timing matters. Texas sets a deadline for death benefit claims. The deadline is generally counted from the date of the worker’s death. Missing it can put the claim at risk. However, the law has some exceptions for good cause and for certain beneficiaries, such as minors. Do not count on an exception. Treat the deadline as firm.
If you are still sorting out what happened, you can still file. You do not need every answer first. As a result, many families file early and send more papers later. For a broader look at the process, see how to file a Texas workers comp claim.
How to Fill It Out and Where to Send It
Start by getting the official form. TDI-DWC lists its forms by number on the TDI forms page. You can also open the official DWC Form-042 PDF directly. Always use the current version from TDI. Older copies may have outdated fields.
DWC Form-042 typically asks for three kinds of information. First, it asks about the worker who died, such as name, employer, and date of death. Second, it asks about the injury or illness and how it was linked to work. Third, it asks about you, the person filing. That includes your relationship to the worker and your contact details. Fill in every box you can. Write “unknown” instead of leaving a field blank.
Common mistakes can slow a claim down. For example:
- Leaving out the employer’s name or the insurance carrier.
- Skipping the signature or date.
- Not including proof of your relationship, such as a marriage or birth certificate, when asked.
- Sending the claim to the employer only, instead of TDI-DWC.
- Filing after the deadline.
Send the completed DWC Form-042 to the Texas Department of Insurance, Division of Workers’ Compensation. The form explains how to submit it. Check the current PDF for the mailing or fax details. Keep a copy of everything you send. Also write down the date you sent it and how.
What Happens After You File
After TDI-DWC gets your DWC Form-042, the claim moves to the insurance carrier. The carrier reviews whether the death is covered and who qualifies. In most cases, the carrier must either start paying or tell you in writing why it disputes the claim. If it disputes the claim, you have the right to challenge that decision through TDI-DWC’s dispute process.
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You may also need to send more papers. For example, the carrier may ask for a death certificate or proof of dependency. Answer these requests quickly. If you are not sure the employer had coverage, read our guide to Texas workers comp requirements. For questions about your file, contact TDI-DWC directly. Confirm any next step and deadline with TDI-DWC and a licensed attorney before acting.
Frequently Asked Questions
Does it cost anything to file DWC Form-042?
The form does not show a filing fee. In most cases, filing a workers’ comp claim with the state is free. Confirm with TDI-DWC if you are unsure.
Can more than one family member file DWC Form-042?
Yes. More than one survivor may qualify for death benefits. For example, a spouse and children may each have a claim. Each person should check with TDI-DWC about whether they need to file their own DWC Form-042.
Do I need a lawyer to file DWC Form-042?
No. You can file DWC Form-042 yourself. However, death claims can involve disputes over coverage or who qualifies. Many families talk with a licensed attorney or TDI-DWC staff to understand their options. That choice is yours.
Dwc form-042: Quick Recap
If you remember one thing about dwc form-042, make it this: the rule is set by the state (or the federal program), not by the insurer, and the official source is linked above. Every figure on this page about dwc form-042 should be confirmed with the agency before you act on it.
Questions about dwc form-042 that this page does not answer are usually answered for free by the state workers’ comp agency’s information line — and, for a disputed claim, by a licensed attorney in a first consultation.
See your state’s exact numbers
What you are owed depends on your state’s benefit caps and deadlines. Start with your state’s settlement and claim guides for the exact figures.
Sources & How to Verify
The figures on this page come from official government and industry sources. Workers’ comp benefit caps, deadlines, and rules change, so always confirm the exact figure with your state’s workers’ comp board or a licensed attorney before acting. Settlement estimates are illustrative, and every case is different.
- Your state workers’ comp board, division, or commission: the official source for your state’s exact caps, deadlines, and forms — search “[your state] workers compensation board”
- U.S. Department of Labor (OWCP): dol.gov — federal workers’ compensation overview
- NCCI: ncci.com — workers’ comp rating and benefit data
- Social Security Administration: ssa.gov — benefit-cap and SSDI offset data
- Insurance Information Institute: iii.org — neutral workers’ comp background
Content last reviewed October 2026. If you notice an outdated figure, please contact us.
Related Guides
- Texas Workers Comp Board
- How to File a Texas Workers Comp Claim
- Texas Workers Comp Requirements
- Workers Comp Settlements by State (All 50)
- Workers Comp Claims by State (All 50)
- More in This Category
- Settlements by Injury
- Benefits Explained
- Workers Comp Glossary
Informational only — not legal, medical, or financial advice. Workers Comp Explained is an independent educational resource, not a law firm, insurer, or medical or financial advisor, and this page does not provide legal, medical, or financial advice. Workers’ compensation benefits, deadlines, and rules vary by state and change over time, and settlement estimates are illustrative only. Always confirm the exact figure and any deadline with your state’s workers’ compensation board and a licensed attorney before you act.