DWC Releases its Annual Compliance and Investigations Audit Plan
DWC Audits and Investigations (A&I) investigates allegations of noncompliance in the Texas workers’ compensation system. A&I processes more than 2,000 allegations of noncompliance every year. A&I conducts more than 50 compliance audits per year of workers’ compensation system participants and prepares confirmed complaints for potential enforcement action.
DWC has published its Compliance and Investigations Audit Plan for Fiscal Year Ending 08/31/26 (https://www.tdi.texas.gov/wc/ci/documents/auditplan26.pdf). For fiscal year (FY) 2026, DWC Compliance and Investigations’ goal is to improve system performance in the following key areas:
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- timely and accurate benefit delivery;
- timely medical reimbursement; and
- timely and accurate reporting of electronic data to the Texas Department of Insurance, Division of Workers’ Compensation (DWC).
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To achieve this goal, DWC will conduct performance audits on select system participants. The Texas Labor Code authorizes DWC to conduct performance audits on participants in the Texas workers’ compensation system. Labor Code Section 402.075 specifically directs DWC to focus its regulatory oversight on insurance carriers and health care providers it identifies as poor performers in the Performance-Based Oversight (PBO) program. You can find detailed information about PBO at www.tdi.texas.gov/wc/pbo/index.html.
This audit plan identifies the issues DWC will review during FY 2026. It describes the scope andmethodology related to each audit type. Please note this audit plan is subject to change because DWC may identify compliance areas of concern, audit risk, or data availability issues. DWC may need to adjust audit issues, who they are auditing, objectives, scope, the review period, and the methodology, as necessary.
Should you have any questions at all about DWC Compliance and Investigations or their 2026 audit plan, please reach out to James Sheffield with the firm: JRS@fol.com.
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