FOLIO

DWC Announces Performance Based Oversight (PBO) 2026 Assessment Plan

Feb 2, 2026 | by FOL

DWC evaluates the performance of workers’ compensation insurance carriers in selected areas of compliance through Performance Based Oversight assessments. See Texas Labor Code §402.075. Insurance carriers are placed into a high, average, or poor regulatory tier based on the outcome.

There are five measures for the 2026 assessment.

Measures
Insurance carriers will be placed into regulatory tiers based on the following measures:

1. Timely payment of initial temporary income benefits by the insurance carrier.
2. Timely reporting of initial payment (IP) data to DWC.
3. Timely processing of initial medical bills by the insurance carrier.
4. Timely processing of requests for reconsideration of medical bills by the insurance carrier.
5. Timely reporting of medical data to DWC via Texas Medical State Reporting Release 1.0.

Selection Criteria
Insurance carriers that reported 20 or more initial payments (IP) of temporary income benefits (TIBs) during the assessment data period will be included.

Data Period
Electronic Data Interchange (EDI) reports accepted by the DWC from January 1, 2026, through June 30, 2026, will be included in the assessment.

Data Sources

• For measures 1 and 2: Texas Claim Release 3.1.4 EDI reports accepted (TA) and accepted with errors (TE) from January 1, 2026, through June 30, 2026.
• For measures 3, 4 and 5: Texas Medical State Release 1.0 EDI reports accepted (TA) and accepted with errors (TE) from January 1, 2026, through June 30, 2026.

Findings & Rebuttals
DWC will determine whether each item was timely or untimely using the claim and medical data reported by the insurance carrier. DWC will send findings and tier ratings to insurance carriers through their Austin Representative.

Carriers may send rebuttals for the following measure:

1 – Timely payment of initial temporary income benefits by the insurance carrier. Rebuttals must be received by the specified deadline. If a response is not received by the deadline, the findings and tier ratings become final.

Scoring and Tier Placement

Measures	Weight	Subtotals
1. Timely payment of TIBS	40 points	Score x 40
2. Timely reporting of initial payment of TIBS	10 points	Score x 10
3. Timeliness of processing initial medical bills	30 points	Score x 30
4. Timeliness of processing requests for reconsideration of medical bills	10 points	Score x 10
5. Timeliness of submission of EDI medical data	10 points	Score x 10

High Tier: 95.00 or greater
Average Tier: 80.00 through 94.99
Poor Tier: 79.99 or less

PBO Schedule 2026

• January 1 – June 30: Claim and medical data is reported by insurance carriers to DWC.
• July: Data is reviewed by DWC.
• July: Findings and tier ratings are sent to the insurance carriers with a rebuttal deadline for the eligible categories.
• August: Rebuttals for eligible categories are reviewed.
• September: Final findings and tier ratings are sent to the insurance carriers.
• October: DWC publishes results.

Publication of Tier Rating
A list of all insurance carriers selected, and their corresponding tier ratings are published on DWC’s website at www.tdi.texas.gov/wc/pbo/index.html.

Impact of Tier Ratings
DWC provides incentives for high performance during PBO. DWC will focus oversight efforts on insurance carriers found to be poor performers in PBO.

The following table describes how PBO tier ratings may affect the insurance carrier during other compliance processes at DWC.

PBO Carrier Tier Rating	DWC C&I Audits	DWC Enforcement Fines/Penalties
High	Exempted*	Consider pursuant to Rule 180.26(e)
Average	Included if selection criteria are met	Consider pursuant to Rule 180.26(e)
Poor	Included regardless of whether selection criteria are met	Consider pursuant to Rule 180.26(e)

(*DWC may audit high-tier performers at its discretion)

Recognition of High Performers
High performers will be recognized on DWCs website and will receive a signed certificate from the commissioner which can be used as a marketing tool.

Reminder regarding compliance, investigations, and enforcement.
DWC may impose sanctions on any insurance carrier that commits an administrative violation. The insurance carrier’s PBO tier rating is one of the factors that DWC is required to consider.

How to Get Assistance with PBO from FO&L
Please reach out to James Sheffield (JRS@fol.com) and Heather Terrones (HTA@fol.com).