Austin, TX – The TDI-DWC recently published its 2024 Insurance Carrier Performance Based Oversight Assessment Plan.
The DWC regularly evaluates insurance carriers and health care providers for compliance with Texas Labor Code §402.075 and 28 Texas Administrative Code §180.19.
The Texas Department of Insurance, Division of Workers’ Compensation (DWC) evaluates the performance of workers’ compensation insurance carriers in selected areas of compliance through Performance Based Oversight assessments.
Insurance carriers are placed into a high, average, or poor regulatory tier based on the outcome.
There are five measures for the 2024 assessment. Insurance carriers will be placed into regulatory tiers based on the following:
- Timely payment of initial temporary income benefits by the insurance carrier.
- Timely reporting of initial payment (IP) data to DWC via Texas Claim EDI Release 3.1.4. Note: This measure will not be factored into the tier placement. (See Scoring and Tier Placement on page 2 of the plan).
- Timely processing of initial medical bills by the insurance carrier.
- Timely processing of requests for reconsideration of medical bills by the insurance carrier.
- Timely reporting of medical data to DWC via Texas Medical State Reporting Release 1.0
Review the full plan: TDI-DWC 2024 Insurance Carrier Performance Based Oversight Assessment Plan (PDF)