The Texas Division of Workers’ Compensation (DWC) announced its plans to audit insurance carriers and healthcare providers in Fiscal Year 2026 to improve system performance.

The goals for the 2026 audit include understanding:

• Timely and accurate benefit delivery
• Timely medical reimbursement
• Timely and accurate reporting of electronic data to the DWC

The DWC will randomly conduct audits on system participants, but will give priority to carriers identified as poor performers under its Performance-Based Oversight program.

The insurance carrier audits will focus on the following areas:

• Accuracy of Benefit Payments and Claims: Determine if lifetime income and death benefits are paid correctly, and the timeliness and accurately of reporting to the DWC. The audit review period will be September 1, 2018 – April 30, 2025
• Medical Billing: Assess whether medical bills are processed timely as well as accurately reported. The audit review period will be July 1, 2025 – September 30, 2025, or October 1, 2025 – December 31, 2025
• Initial Temporary Income Benefits (TIB): Examine if TIB payments are made timely and reported accurately. The audit review period will include July 1, 2025 – September 30, 2025, or October 1, 2025 – December 31, 2025

With FY 2026 audits targeting accuracy, timeliness, and completeness, early insights help stakeholders to align systems and reduce compliance risk. Even carriers not selected for audit can benefit from the eventual findings, which often highlight emerging trends and shape future regulations and strategic decisions.