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  Workers' Compensation Information  

Workers’ Compensation Procedures

Do not file work related injuries on your group medical or prescription plans. File only with the Workers’ Compensation Carrier.

If you are injured while at work:

  • Report your injury to your supervisor immediately
  • See campus nurse for evaluation if possible
  • Complete injury forms and return to benefits
  • Visit Network Physician as necessary
  • Notify supervisor and benefits department of work status

Forms to be Completed:

Workers' Compensation Forms Packet

Complete and Return to Benefits

  • Employee Acknowledgment of Workers’ Compensation Network form
  • Employee Choice to Use Paid Leave form
  • Accident Investigation Form

Employee Keeps

  • Workers' Compensation Temporary Income Benefits and your Waller ISD Pay document
  • Workers’ Compensation Information document
  • Workers' Compensation Verification of Coverage document
  • Texas Star Network Clinics/Physicians near Waller document
  Contact Information  
Employee Benefits Administrator
Becky Jimenez
Phone: 936-372-4037
Fax: 936-931-4080

Workers’ Compensation Carrier
Texas Mutual
Pharmacy Info: Cypress Care
Pharmacy Phone:
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