The Texas Division of Workers’ Compensation held its quarterly stakeholder meeting on October 14, 2026. Healthesystems attended to capture key updates, which included:

• Topical analgesic prescribing
• Network performance
• Treatment guideline updates
• Dispute resolution
• Legislative priorities

Topical Analgesic Prescribing

The topical analgesic audit is reviewing up to five cases for each of 24 health care providers selected by prescribing volume. Reviewers will assess medical necessity, diagnosis appropriateness, ODG consistency, and documentation of meaningful benefit for extended treatment. Medication cost is not part of the audit. The DWC expects to complete the review around February and publish an executive summary of aggregate findings and recommendations.

Network Performance

The DWC’s 2026 Workers' Compensation Network Report Card found that network claims generally had lower costs, faster care, higher satisfaction, earlier return to work, and fewer missed-work weeks than non-network claims, although some individual networks had higher costs.

Separately, the DWC stated that their forthcoming Health Care Cost and Utilization report found that average service-year cost per claim remained near $3,400, while average injury-year cost increased 6%, from approximately $3,400 in 2020 to $3,620 in 2024. The DWC noted that COVID-related disruptions affected earlier-year trends.

Treatment Guideline Updates

Effective October 1, 2026, revised 28 TAC §137.10 replaced the MD Guidelines with ODG for non-network return-to-work determinations, including applicable designated doctor examinations. DWC Form-073 requirements did not change. Designated doctors must subscribe to the adopted treatment and return-to-work guidelines and use the DWC’s designated doctor training page to complete or review the required training and submit an attestation.

The DWC also reminded carriers to provide designated doctors with all medical records at least three working days before an appointment to avoid rescheduling. The DWC encouraged use of the DD Scheduler email rather than fax for requests unavailable through TXCOMP. Separately, the DWC concluded the 2026 carrier performance-based oversight process on September 22, 2026, and sent carriers their results and high-tier certificates. The tier ratings are also posted online.

The DWC is also considering moving from the AMA Guides, Fourth Edition, to the Sixth Edition for impairment ratings. The newer methodology emphasizes diagnosis, objective findings, evidence-based medicine, functional impact, and applicable modifiers to reduce subjectivity and improve rating consistency. No implementation decision or effective date was announced.

Dispute Resolution

Screenshots shared during the meeting provided a preview of the forthcoming online medical fee dispute portal, including immediate tracking numbers, electronic correspondence, dispute-status tracking, and direct carrier response uploads. Closed disputes will remain available for six months. Carriers may still respond by email, fax, or SFTP and must continue copying the requesting provider. DWC said the portal will launch soon but gave no date.

Virtual contested case hearings continued to increase, accounting for 20% of hearings in September 2026. DWC also launched Zoom access to interpreters for in-person hearings in six offices. All scheduled hearings proceeded despite technical challenges, and those issues were later resolved.

Although overall compliance and enforcement results were generally similar to the prior year, complaint volume increased somewhat from 2,043 to 2,283. The DWC noted that AI-generated submissions and matters more appropriately handled through the dispute or hearing process may have contributed to the increase. Two complaint trends stood out: health care provider communications complaints increased from 202 to 318, driven largely by late designated doctor reports, while carrier indemnity-benefit complaints increased from 612 to 735. The three most frequent enforcement violations were late designated doctor reports, failure to pay or dispute medical bills within 45 days, and untimely filing or inaccurate payment of accrued temporary income benefits.

Death-benefit compliance improved significantly, which the DWC attributed to carriers’ efforts to review their records and ensure compliance. For the upcoming audit, carriers can avoid audit penalties by self-reporting and correcting death- or lifetime-income-benefit noncompliance before notices are issued, which DWC targeted for around October 28th. Complaints may still be filed, but self-reporting will be mitigating; high PBO performers are exempt.

Legislative Priorities

For the upcoming legislative session, the DWC is considering recommendations to modernize electronic benefit payments and eliminate non-subscriber reporting. Its largest proposal is a request for approximately $34 million to fund the first phase of a broader replacement of DWC’s legacy dispute-resolution system, with online filing, docketing, document uploads, and real-time status updates. DWC is considering the Subsequent Injury Fund as a potential funding source, which would avoid an additional carrier surcharge. This approach would require legislative approval, a statutory change, and confirmation of the fund’s financial health.

A fuller legislative preview is expected at the next quarterly meeting tentatively scheduled for January 20, 2027.