The Texas Division of Workers' Compensation (DWC) released its fiscal year 2025 audit plan, focused on improving system performance.

While audits will be randomly selected, the DWC is required by state law to prioritize oversight of insurance carriers and healthcare providers identified as poor performers under the Performance-Based Oversight program.

The DWC’s Compliance and Investigations Unit will focus audits on three key areas.

Timely Reimbursement and Reporting of Medical Bills: This audit will evaluate whether medical bills were processed promptly and if required data was accurately and timely reported electronically to the DWC. It will cover bills submitted from September 1, 2021, to November 30, 2024, or December 1, 2024 to February 28, 2025, based on the audit start date.

Timely and Accurate Benefit Delivery:  The audit will assess whether insurance carriers accurately paid lifetime income and death benefits and properly reported claim data to the DWC. It will review claims for injuries occurring between September 1, 2017, and April 1, 2024.

Timely Payment of Initial Temporary Income Benefits (TIB):  This audit will evaluate the timeliness and accuracy of initial TIB payments and related data, focusing on payments made from July 1 to September 30, 2024, or October 1 to December 31, 2024, based on the audit start date.