The Texas Department of Insurance, Division of Workers’ Compensation published their Compliance and Investigations Audit Plan for Fiscal Year Ending August 31, 2027. The goal of the audit plan is to improve system performance in the timely and accurate delivery of benefits and reporting of electronic data to the TDI-DWC.

Two types of audits will be conducted. The first is an audit on the accuracy of lifetime income benefits (LIB) and death benefits (DB). For this first audit type, the DWC will select claims where an initiation of death benefits or lifetime income benefits were issued in calendar year 2025. Two rounds of audits will take place, with about 30 carriers audited in each. Insurance carriers will randomly be assigned to either the first or second round of the audit.

For each claim reviewed, the DWC will require insurance carriers to submit the wage statement, indemnity payment records, adjuster notes, and other claim documents. The record will be reviewed to determine if the payment amounts and data reporting were accurate.

The second audit type will be for the timely paying of initial temporary income benefits, the timely reporting of initial payment data, and the accuracy of initial payment data. The audit samples will consist of randomly selected records drawn from the DWC’s database of claim information that insurance carriers submitted to the DWC.

The DWC will draw the sample data from claims where an insurance carrier issued an initial TIB payment during the period of September 1, 2026, through November 30, 2026. For each claim reviewed, DWC will require insurance carriers to submit:

• DWC Form-001, Employer’s First Report of Injury or Illness
• Plain Language Notices
• Notification of First Temporary Income Benefit Payment
• Adjuster/claim notes
• Medical reports
• Initial TIB payment details

The DWC will review the records to determine if the insurance carriers timely issued each initial TIB payment and timely and accurately reported the initial payment data elements to DWC.