The Texas Division of Workers’ Compensation (DWC) has approved a new Designated Doctor Plan-Based Audit to evaluate the medical necessity and reasonableness of referrals and diagnostic testing ordered by designated doctors.

These specially trained providers are appointed by the DWC to assess an injured worker’s condition or resolve disputes, and while exams may be requested by multiple parties, the DWC determines whether one is assigned.

The audit will also review how designated doctors incorporate referral information and test results into their narrative reports, with the goal of reinforcing evidence-based, cost-effective care, ensuring referrals and testing are medically justified and well documented, and improving the timeliness of dispute resolution and return-to-work decisions.

All medical quality reviews initiated on or after January 1, 2026, will follow the updated Medical Quality Review Process.

This new audit helps protect carriers from unnecessary costs and ensures compliance with evidence-based standards. This promotes accurate diagnoses, reduces overutilization, and strengthens the integrity of the workers’ compensation system. For carriers, this means better claim outcomes, and stronger defenses in disputes, supporting cost containment and system transparency.