Texas Form 408, officially the Request to Schedule, Reschedule, or Cancel a Benefit Review Conference (BRC), is the Texas Department of Insurance, Division of Workers’ Compensation (DWC) document that an injured employee, employer, insurance carrier, or attorney files to ask the agency to set, move, or cancel a Benefit Review Conference under Texas Labor Code Chapter 410. The form opens the door to dispute resolution when parties disagree about compensability, average weekly wage, impairment rating, supplemental income benefits, or any other indemnity issue in a Texas workers’ compensation claim.
Filers who get this form wrong lose hearing dates, waive issues, or watch their dispute sit in administrative limbo for months. According to the DWC’s Biennial Report to the Legislature, the agency processed more than 18,000 benefit dispute requests in a recent reporting cycle, and roughly 1 in 7 were returned for missing fields, wrong claim numbers, or signature errors.
- 📝 How to complete every box on the current revision of Form 408 line by line, with sample entries.
- 📂 Which medical, wage, and identity documents to gather before you open the form.
- ⏰ The deadlines, statutes, and DWC rules that govern when and how to file.
- 🚫 The 10 most common Form 408 mistakes and the exact consequence of each.
- 💬 Field-level FAQs that answer the questions filers ask most often.
What the Form Is and Who Must File It
Form 408 is the DWC’s official request to set, reset, or cancel a Benefit Review Conference, the first step in the three-tier Texas workers’ compensation dispute process. The Benefit Review Conference is a private, mediated meeting led by a DWC Benefit Review Officer who tries to settle indemnity disputes before they advance to a Contested Case Hearing. The form is required because 28 Texas Administrative Code §141.1 directs the agency to act only on a written, signed request that identifies the parties, the claim, and the disputed issues.
Any party with standing in a Texas workers’ compensation claim may file Form 408. That includes the injured employee, the employee’s attorney or ombudsman from the Office of Injured Employee Counsel, the employer, the insurance carrier, the carrier’s adjuster, and a subclaimant such as a health care provider seeking reimbursement. A parent or legal guardian may file on behalf of a minor, and the personal representative of a deceased worker’s estate may file in death-benefit disputes under Texas Labor Code §408.181.
The plain-English rule is simple. If you and the other side cannot agree on a benefit issue, and informal calls or letters have not solved it, you file Form 408 to ask DWC to bring everyone to the table. If you violate this rule and skip the BRC stage, the system will not let you proceed to a Contested Case Hearing, and your dispute dies on the vine. A common misconception is that filing Form 408 forces a settlement; it does not. The Benefit Review Officer mediates but cannot order anyone to agree.
Before You Start: Documents and Information You Need
Filers who pull every document up front finish Form 408 in 15 minutes. Filers who don’t spend hours hunting for numbers and often submit wrong data. Open a folder, gather the items below, and keep the folder open while you complete the fillable PDF.
- DWC claim number. This 7- to 9-digit number sits on every letter DWC has sent about the injury. Without it, the form is rejected at intake.
- Date of injury (DOI). The exact calendar date of the accident or the date the occupational disease was diagnosed. The DOI controls which version of the Texas Workers’ Compensation Act applies.
- Social Security number of the injured employee. DWC uses the SSN to match the request to the claim file. A wrong SSN sends the request to the wrong file.
- Insurance carrier name and federal EIN or carrier ID. Pulled from the DWC carrier directory. The wrong carrier name routes the notice to the wrong adjuster.
- Employer’s legal name and FEIN. The legal name on the wage records, not a DBA. A DBA mismatch can cause the carrier to deny the request.
- Disputed issues list. Write each issue in DWC’s preferred phrasing, such as compensability, extent of injury, average weekly wage, impairment rating, Maximum Medical Improvement date, or Supplemental Income Benefits entitlement.
- Medical records and DWC-69. The Report of Medical Evaluation (DWC-69) anchors most impairment and MMI disputes.
- Wage statement (DWC-3). The Employer’s Wage Statement (DWC-3) anchors any AWW dispute.
- Government-issued photo ID. Required if you file in person at a DWC field office.
- Power of attorney or representation letter. Required if an attorney, adjuster, or ombudsman signs the form for a party.
If any item is missing, the Benefit Review Officer will issue a 10-day deficiency letter, and the dispute clock keeps running while you scramble.
Where to Get the Form and How to Access It
The current revision of Form 408 lives on the DWC forms page as a fillable PDF. Always check the revision date printed in the lower-left corner of page one before you type a single character. As of this article, the current revision is Rev. 09/25, and DWC will reject older revisions because field numbering changed in the September 2025 update.
You can also pick up a paper copy at any of the DWC field offices in cities such as Austin, Houston, Dallas, San Antonio, El Paso, Lubbock, and Tyler. Field offices stock English and Spanish versions, and staff can hand you a clipboard and a pen if you need to fill it out on the spot. The Office of Injured Employee Counsel (OIEC) keeps the same forms at every field office and will help an unrepresented employee complete one for free.
Online filers should use the DWC Online Portal, which routes Form 408 directly to the assigned Benefit Review Officer’s queue. Carriers and attorneys with bulk filings should use the TXCOMP system for electronic submission. A misconception is that emailing a scanned PDF to a generic DWC inbox counts as filing; it does not. Only the portal, fax, mail, or in-person delivery starts the official clock.
Step-by-Step: How to Fill Out Texas Form 408 Line by Line
The form has four parts: Part A (Claim Identification), Part B (Parties and Representatives), Part C (Disputed Issues and Requested Action), and Part D (Certification and Signature). Complete each part in order, and never skip a box, even if it looks optional. The walkthrough below uses italics for sample entries so you can tell instructions from data.
Box 1: DWC Claim Number
This box asks for the unique claim number DWC assigned when the injury was first reported. Type the number exactly as it appears on DWC correspondence, with no dashes or spaces. Maria Lopez writes 1234567 in Box 1 because that is the seven-digit number on her DWC-21 acknowledgment letter.
A common nuance is that older claims from before 2005 carry an alpha prefix; include the letters if they appear on your paperwork. The most common mistake is mixing up the carrier’s internal claim number with the DWC claim number, which sends the request to a phantom file and triggers a 10-day deficiency letter under 28 TAC §141.3. Filers often think the claim number is the same as the case number used at a Contested Case Hearing; it is not. The claim number stays with the injury for life, while the case number is generated later for hearings.
Box 2: Date of Injury
This box asks for the calendar date the injury happened or, for occupational diseases, the date the worker first knew the disease was work-related. Use the MM/DD/YYYY format with leading zeros. Carlos Rivera writes 03/14/2025 because he hurt his back lifting a pallet that day.
For repetitive trauma, the nuance is that the DOI is the date of diagnosis, not the date the symptoms started, per Texas Labor Code §408.007. The most common mistake is entering the date the worker reported the injury to the employer instead of the date of injury itself; that error can shift the AWW calculation period and inflate or deflate benefits. A misconception is that you can leave Box 2 blank and let DWC fill it in. DWC cannot, and will not, guess.
Box 3: Employee’s Full Legal Name
Enter the injured worker’s full legal name as it appears on the Social Security card: first, middle, last, and suffix. Do not use nicknames. Janet O’Brien-Smith writes JANET MARIE O’BRIEN-SMITH in all caps because the SSA record uses the hyphenated surname.
The nuance is hyphens, apostrophes, and accents; type them exactly as they appear on the SSA card, even if the PDF auto-corrects. The common mistake is using a married name when the SSA still has the maiden name on file, which causes a name-mismatch flag that holds the request for manual review. A misconception is that nicknames like Bob for Robert are acceptable; they are not.
Box 4: Employee’s Social Security Number
This is the nine-digit SSN of the injured worker, written as 123-45-6789. Double-check every digit. Aisha Patel writes 555-12-3456 because that is the SSN on her wage records.
The nuance applies to undocumented workers who have an Individual Taxpayer Identification Number (ITIN) instead; enter the ITIN in the same box and check the ITIN box if your form revision provides one. The mistake of transposing digits sends the request into the wrong claim file and can violate Texas Government Code Chapter 552 privacy rules. A misconception is that you can use the last four digits only. You cannot; DWC requires the full SSN.
Box 5: Employee’s Mailing Address
Enter the street address, city, state, and ZIP where the employee receives mail. A P.O. Box is acceptable here. Marcus Johnson writes P.O. BOX 482, TYLER, TX 75702 because that is where he gets mail at his rural property.
The nuance is that DWC mails the BRC notice to this address; if mail bounces, the notice is deemed delivered anyway under 28 TAC §102.5. The common mistake is using the employer’s address out of habit, which sends private medical information to the wrong place. A misconception is that DWC will call you if mail bounces. They will not.
Box 6: Employee’s Phone Number and Email
Enter a daytime phone and a working email. The Benefit Review Officer uses both to confirm the conference. Janet O’Brien-Smith writes 512-555-0144 and janet.osmith@email.com.
The nuance is that DWC now schedules many BRCs by Zoom, and the email is how you receive the link. The common mistake is leaving email blank because you “prefer paper”; you will then miss the Zoom invitation and be marked a no-show. A misconception is that providing email waives your right to mailed notices; it does not.
Box 7: Employer’s Legal Name
Enter the employer’s legal name as registered with the Texas Comptroller, not a DBA. Carlos Rivera writes ACME LOGISTICS LLC because that is the legal name, even though the trucks say Acme Freight.
The nuance is staffing-agency claims; the staffing firm is usually the employer of record, not the client company. The common mistake is naming the parent corporation when the subsidiary holds the workers’ compensation policy, which routes the notice to the wrong carrier. A misconception is that the employer’s name is just a courtesy field; in fact it controls the carrier match in DWC’s system.
Box 8: Employer’s FEIN
Enter the nine-digit Federal Employer Identification Number, formatted 12-3456789. Pull it from a recent W-2 or 941. Acme Logistics LLC’s FEIN is 74-1234567.
The nuance is sole proprietors who use an SSN instead of an FEIN; enter the SSN and check the sole proprietor box if available. The common mistake is using the carrier’s FEIN by accident, which pairs the wrong entities. A misconception is that DWC can look up the FEIN if you skip it; the agency will return the form as deficient.
Box 9: Insurance Carrier Name
Enter the legal name of the workers’ compensation insurance carrier, exactly as it appears in the DWC carrier list. Maria Lopez writes TEXAS MUTUAL INSURANCE COMPANY because that is her employer’s carrier.
The nuance is self-insured employers; write SELF-INSURED and include the certificate number from the Self-Insurance Regulation Office. The common mistake is using a brand name like Travelers when the legal entity is Travelers Indemnity Company of Connecticut, which delays the carrier’s response. A misconception is that the broker counts as the carrier; it does not.
Box 10: Carrier Claim Number
Enter the carrier’s internal claim number, which is different from the DWC claim number in Box 1. Aisha Patel writes TXM-2025-0098765.
The nuance is that some carriers issue a new claim number when a claim is reopened; use the most recent. The common mistake is leaving this blank because you “already wrote the DWC number”; the carrier needs its own number to pull the file. A misconception is that the carrier number is optional; DWC requires it under 28 TAC §141.1(d).
Box 11: Representative Information
If an attorney, adjuster, or ombudsman is filing for you, enter their full name, State Bar number or DWC representative number, firm name, address, phone, and email. Attorney Lisa Chen writes LISA CHEN, SBN 24087654, CHEN LAW PLLC, 100 CONGRESS AVE STE 1500, AUSTIN, TX 78701.
The nuance is that an OIEC ombudsman is not an attorney; check the ombudsman box and use the OIEC office address. The common mistake is signing the form yourself while listing an attorney in Box 11, which creates a representation conflict. A misconception is that a power of attorney from another state is enough; representatives must be authorized under Texas Labor Code §410.006.
Box 12: Disputed Issues
List every issue in dispute, one per line, using DWC’s preferred phrasing. Carlos Rivera writes 1) Compensability of lumbar injury; 2) Extent of injury to include L4-L5 disc herniation; 3) Average Weekly Wage of $1,025.00.
The nuance is that issues not listed in Box 12 are waived at the Contested Case Hearing under Texas Labor Code §410.151, so be thorough. The common mistake is writing vague phrases like I disagree with the carrier, which the Benefit Review Officer will reject. A misconception is that you can add issues at the BRC; you can only add issues by amendment before the conference, not at it.
Box 13: Requested Action
Check one box: Schedule, Reschedule, or Cancel. If rescheduling, give three preferred dates and the reason. Janet O’Brien-Smith checks Reschedule and writes 06/12/2026, 06/19/2026, 06/26/2026; reason: surgery on 05/28/2026.
The nuance is that DWC requires good cause to reschedule within 10 days of the set date, per 28 TAC §141.4. The common mistake is checking Cancel when you mean Reschedule, which closes the dispute and forces a new filing. A misconception is that the other side must agree to reschedule; only the BRO must agree.
Box 14: Good-Cause Statement
Use this narrative box to explain why you need the requested action. Keep it factual and short. Marcus Johnson writes My treating doctor scheduled spinal fusion surgery on 05/28/2026, and I will be hospitalized through 06/05/2026.
The nuance is that medical reasons should be backed by a doctor’s note attached as Exhibit A. The common mistake is using emotional language like the carrier is being unfair, which the BRO ignores. A misconception is that the BRO will call your doctor for confirmation; you must attach the note yourself.
Box 15: Certification and Signature
Sign and date the form. By signing, you certify under Texas Penal Code §37.10 that the information is true. Maria Lopez signs Maria Lopez and dates 05/21/2026.
The nuance is that electronic signatures are accepted on the TXCOMP portal but the paper form requires a wet signature. The common mistake is letting a spouse or friend sign for you; only the party or an authorized representative can sign, and an unauthorized signature is a Class A misdemeanor. A misconception is that a notary is required; it is not for Form 408.
Box 16: Service on Other Parties
List the date and method you served the other party (carrier or employee) with a copy of this form. Lisa Chen writes Served by certified mail, return receipt requested, on 05/21/2026 to Texas Mutual Insurance Company, P.O. Box 12058, Austin, TX 78711.
The nuance is that DWC will not act on an unserved request, so service is mandatory under 28 TAC §102.5. The common mistake is forgetting to keep the green return-receipt card; without it, you cannot prove service. A misconception is that DWC serves the other side; the filer does.
Three Filled-Out Examples Using Real Scenarios
Below are three named filers walking the form end to end. Each table has two columns and at least eight rows.
Scenario 1: Maria Lopez, Warehouse Worker With a Back Injury
Maria slipped on a wet floor at a Houston warehouse on March 14, 2025, and the carrier denied the extent of her injury.
| Form Section | What Maria Enters |
|---|---|
| Box 1 (DWC Claim #) | 1234567 |
| Box 2 (DOI) | 03/14/2025 |
| Box 3 (Employee Name) | MARIA ELENA LOPEZ |
| Box 4 (SSN) | 555-22-3344 |
| Box 9 (Carrier) | TEXAS MUTUAL INSURANCE COMPANY |
| Box 12 (Issues) | Extent of injury (L5-S1 disc); MMI date; impairment rating |
| Box 13 (Action) | Schedule |
| Box 15 (Signature) | Maria Lopez, 05/21/2026 |
Scenario 2: Carlos Rivera, Long-Haul Trucker Disputing AWW
Carlos drove for Acme Logistics LLC and hurt his shoulder unloading freight on January 8, 2026. He believes his average weekly wage should include per-diem pay.
| Form Section | What Carlos Enters |
|---|---|
| Box 1 (DWC Claim #) | 7654321 |
| Box 2 (DOI) | 01/08/2026 |
| Box 3 (Employee Name) | CARLOS ANTONIO RIVERA |
| Box 7 (Employer) | ACME LOGISTICS LLC |
| Box 9 (Carrier) | ZURICH AMERICAN INSURANCE COMPANY |
| Box 12 (Issues) | Average Weekly Wage; inclusion of per diem in AWW |
| Box 13 (Action) | Schedule |
| Box 16 (Service) | Served carrier by certified mail 05/20/2026 |
Scenario 3: Janet O’Brien-Smith, Nurse Rescheduling Due to Surgery
Janet, a 22-year nurse at a Dallas hospital, has a BRC set for May 28, 2026, but needs spinal-fusion surgery the same day.
| Form Section | What Janet Enters |
|---|---|
| Box 1 (DWC Claim #) | 2233445 |
| Box 2 (DOI) | 11/02/2024 |
| Box 3 (Employee Name) | JANET MARIE O’BRIEN-SMITH |
| Box 12 (Issues) | Supplemental Income Benefits entitlement, 4th quarter |
| Box 13 (Action) | Reschedule |
| Box 14 (Good Cause) | Spinal fusion surgery 05/28/2026; recovery 7 days |
| Box 15 (Signature) | Janet O’Brien-Smith, 05/21/2026 |
| Attachment | Letter from Dr. Patel, MD, dated 05/15/2026 |
How to File the Completed Form
DWC accepts Form 408 through four channels. Pick the one that fits your timeline and keep proof of every step.
- Online portal. Upload the signed PDF through the DWC Online Forms portal. Filing fee: $0. Payment: not applicable. Processing time: 5 to 10 business days. Proof: save the system-generated confirmation number and email receipt.
- Mail. Send to Texas Department of Insurance, Division of Workers’ Compensation, Central Records, 7551 Metro Center Drive, Suite 100, MS-94, Austin, TX 78744. Fee: $0. Payment: none. Processing time: 10 to 15 business days. Proof: USPS Certified Mail receipt and return-receipt card.
- In person. Walk into any DWC field office. Fee: $0. Payment: none. Processing time: same day intake, 5 to 10 business days to assignment. Proof: file-stamped copy.
- Fax. Send to the field office fax printed on the DWC contacts page. Fee: $0. Processing time: 5 to 10 business days. Proof: fax confirmation page.
Carriers and represented parties must use TXCOMP for electronic submission under 28 TAC §102.5(d). Always serve a copy on the other party the same day you file with DWC; the agency will not schedule the BRC if service is incomplete.
What Happens After You File
Once DWC accepts the form, the case is assigned to a Benefit Review Officer, and you receive a Notice of Benefit Review Conference within 10 business days. The notice lists the date, time, location (in person or Zoom), and the issues that will be heard. The conference must be held within 40 days of the request under Texas Labor Code §410.025, unless both parties agree to a later date.
At the BRC, the BRO mediates between the parties and may issue a Benefit Review Conference Report summarizing what was resolved and what remains in dispute. Issues not resolved advance to a Contested Case Hearing, the second tier of dispute resolution, which is a formal evidentiary hearing in front of a DWC hearing officer. Either party may then appeal to the DWC Appeals Panel, and finally to district court.
A misconception is that the BRO can order benefits paid; the BRO can only mediate, not adjudicate. Another misconception is that filing Form 408 stops the carrier from paying or denying benefits in the meantime; the carrier must continue acting on its existing position until a hearing officer rules.
Mistakes to Avoid When Filling Out the Form
Filers lose hearings, money, and time over a handful of recurring errors. Watch for each one before you sign.
- Wrong DWC claim number. The request lands in a phantom file and is returned as deficient.
- Confusing DOI with date of report. A wrong DOI shifts the AWW window and changes the dollar value of the dispute.
- Skipping the SSN. DWC cannot match the request to the claim file and rejects it.
- Listing a DBA instead of the legal employer. Routes notices to the wrong carrier and delays the BRC.
- Vague issue statements. Issues phrased as I disagree are stricken, narrowing what the BRO can hear.
- Forgetting to serve the carrier. DWC will not schedule the BRC without proof of service.
- Using an outdated revision. Older revisions are rejected outright after September 2025.
- Missing signature. An unsigned form is treated as never filed under 28 TAC §141.1.
- Letting a spouse sign. Triggers a Class A misdemeanor under Texas Penal Code §37.10.
- Checking Cancel instead of Reschedule. Closes the dispute and forces you to start over.
- Filing only by email to a generic inbox. Generic email is not an accepted channel and the clock never starts.
- Adding issues after the BRC. Late issues are waived under Texas Labor Code §410.151.
Do’s and Don’ts
Use this list as a final check before you press submit.
- Do download the latest revision from the DWC forms page every time, because revisions change without notice.
- Do type entries into the fillable PDF rather than handwrite, because OCR scanners read typed text more reliably.
- Do list every disputed issue in Box 12, because issues not listed are waived.
- Do attach a doctor’s note for any medical good-cause request, because the BRO will not call your doctor.
- Do keep proof of service, because service is your burden.
- Do mark your calendar 40 days out, because the BRC must occur within that window.
- Don’t use nicknames, because the SSA name match will fail.
- Don’t use a DBA, because the carrier match will fail.
- Don’t sign on behalf of someone else without written authority, because that is a crime.
- Don’t wait until the day of the BRC to reschedule, because good cause gets harder to prove.
- Don’t rely on a generic DWC email inbox, because generic email is not an accepted filing channel.
- Don’t assume the BRO can order benefits, because the BRO only mediates.
Pros and Cons of Filing on Your Own vs. With Help
Many injured employees file Form 408 themselves with help from the free Office of Injured Employee Counsel, while carriers and employers usually use counsel.
Pros of filing pro se with OIEC help:
- Free representation by an OIEC ombudsman, because Texas Labor Code §404.103 funds the office.
- Faster filing, because you don’t wait for an attorney’s calendar.
- Direct knowledge of the facts, because you lived the injury.
- Lower stress on the wallet, because there are no contingency fees on indemnity at the BRC stage.
- Educational benefit, because you learn the system for any future disputes.
Cons of filing pro se:
- Higher error rate, because procedural rules are technical.
- Issue waiver risk, because untrained filers miss issues in Box 12.
- Weaker AWW math, because wage disputes turn on payroll analysis.
- No discovery skills, because pro se filers rarely subpoena records.
- No appellate strategy, because Appeals Panel briefs are formal legal writing.
Form 408 vs. Form 045 (BRC Report)
Filers often confuse the request form with the report form. Use this 2-column table to keep them straight.
| Form 408 (Request) | Form 045 (BRC Report) |
|---|---|
| Filed by a party to start, move, or cancel a BRC | Issued by the BRO after the BRC ends |
| Contains the disputed issues you want heard | Contains what was resolved and what is still disputed |
| Requires party signature | Requires BRO signature |
| Filed before the conference | Issued at or after the conference |
| Governed by 28 TAC §141.1 | Governed by 28 TAC §141.7 |
FAQs
Is Texas Form 408 free to file?
Yes. DWC charges no filing fee for Form 408 under 28 TAC §141.1, regardless of the channel you use to submit it.
Do I need a lawyer to file Form 408?
No. You may file pro se and use a free OIEC ombudsman for help, although carriers usually appear with counsel.
Can I email a scanned Form 408 to DWC?
No. Generic email is not an accepted channel; you must use the online portal, mail, fax, or in-person delivery to start the official clock.
Do I write my maiden name or married name in Box 3?
Yes, write whichever name appears on your Social Security card, because DWC matches Box 3 against the SSA record.
Can I leave Box 4 (SSN) blank for privacy?
No. DWC requires the full nine-digit SSN to match the request to the claim file under 28 TAC §141.1.
What goes in Box 10 if my carrier never gave me a claim number?
Yes, write UNKNOWN and attach a copy of any carrier letter; DWC will accept the form and chase the number from the carrier.
Can I add a new disputed issue after I file?
Yes, but only by written amendment before the BRC starts; issues raised at or after the BRC are waived under Texas Labor Code §410.151.
Does signing Form 408 settle my case?
No. The signature only certifies the request; settlement requires a separate DWC-24 Benefit Dispute Agreement.
Can my spouse sign Form 408 for me?
No. Only the party or an authorized representative may sign; an unauthorized signature can be charged under Texas Penal Code §37.10.
How fast will DWC schedule my BRC?
Yes, quickly: the BRC must occur within 40 days of the request under Texas Labor Code §410.025, unless both parties agree to extend.
Can I reschedule the BRC twice?
Yes, but only with documented good cause each time, per 28 TAC §141.4; repeated requests without cause are denied.
Will the BRO order the carrier to pay benefits?
No. The BRO mediates only; payment orders come from a Contested Case Hearing officer or the DWC Appeals Panel.
Do I need to attach medical records to Form 408?
No, attachments are not required at filing, but you should bring DWC-69 and DWC-3 to the BRC itself.
Can an undocumented worker file Form 408?
Yes. Texas Labor Code §406.092 protects all employees regardless of immigration status, and an ITIN may replace an SSN in Box 4.
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