The Texas Division of Workers’ Compensation (TX DWC) apparently understands its mission to uphold the integrity of the state’s workers’ comp system.

The agency released its Audit Plan for 2026, by which the TX DWC will identify payers that fail to:

• Timely reimburse providers for injured workers’ treatment
• Timely report accurate medical bill data to the state

The TX DWC will conduct 65 audits of payers the agency deemed “poor performers” in its Performance-Based Oversight program. This program ranks insurance carriers according to their compliance with workers’ compensation laws and regulations.

Unlike some other state workers’ comp agencies, the TX DWC consistently collects and reviews critical workers’ comp data. Rather than rely on unverifiable figures from insurer-funded advocacy groups, Texas does the work necessary to incentivize compliance and protect the system from abuse.  

Real Enforcement in TX: PBO and Audits

Texas Labor Code Section 402.075(c) mandates that the TX DWC assess selected providers and insurance carriers every two years:

“At least biennially, the division shall assess the performance of insurance carriers and health care providers in meeting the key regulatory goals. The division shall examine overall compliance records and dispute resolution and complaint resolution practices to identify insurance carriers and health care providers who adversely impact the workers' compensation system and who may require enhanced regulatory oversight.”

In even-numbered years, assessments under the PBO program evaluate insurance carriers based on five categories:

1. Timely payment of Temporary Income Benefits (TIBs)
2. Timely reporting of initial payment of TIBs to the TX DWC
3. Timeliness of processing initial medical bills
4. Timeliness of processing requests for reconsideration of medical bills
5. Timeliness of submission of the EDI medical data to the TX DWC

Based on those assessments, the TX DWC ranks insurance carriers as “High,” “Average,” or “Poor” performers. The names of the carriers in each category are made public on the Texas Department of Industrial Relations (TDI) website.

Following the PBO assessments, §402.75 directs the TX DWC to “...focus its regulatory oversight” on the “Poor” Tier.

The TX DWC publicizes its planned schedule of audits, including which violations they intend to investigate, which specific statutes and rules payers might be violating, and how many insurance carriers the agency will audit. Further details about the audit process are on the TDI website.

Most importantly for providers, the Audit Plan includes specific investigations into whether carriers timely process providers’ bills, timely report medical bill data, and accurately report medical bill data.

Reliable Data = Incentives for Compliance

It’s especially heartening to see that the TX DWC specifically investigates the timeliness and accuracy of the medical bill data that insurance carriers submit to the state.

Although the TX DWC relies in part on self-reported data, the agency does not blindly trust payers to share the data necessary to evaluate compliance…unlike the California Division of Workers’ Compensation (CA DWC).

The CA DWC openly declared that submitting data to the state’s Workers’ Compensation Information System (WCIS) is “voluntary,” violating state law. The California DWC has also refused since 2016 to facilitate Utilization Review (UR) data reporting, also in violation of state law.

As a result, California legislators make major policy decisions, like raising employers’ workers’ comp rates, based on voluntarily self-reported, unverifiable data from insurers.

Texas offers a better model, one that prioritizes accountability for participants on both sides of the provider/payer divide, benefiting injured workers statewide.

Nationwide, daisyBill increases revenue and decreases hassle for providers who treat injured workers. Get a free demonstration below.

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