Notice of Disputed Issue(s) and Refusal to Pay Benefits
Phone (toll-free): _____ _ Fax / email: _____ If you would like to get letters by fax or email, send your fax number or email address to me. If we are not able to resolve an issue after you contact me: Call the Texas Department of Insurance, Division of Workers’ Compensation at 1-800-252-7031, Monday to Friday, 8 a.m. to 5 p.m. Central time. ................
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