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February 10, 2015

Division of Workers’ Compensation Recovers More than $500,000 Owed to Injured Employees and Beneficiaries

AUSTIN, TX –The Division of Workers’ Compensation (DWC) conducted performance audits of several insurance carriers on the accuracy of payments of Lifetime Income Benefits (LIBs) and Death Benefits (DBs). Through these audits, DWC discovered underpayments on 64 claims totaling over $511,000.

“One of my chief compliance priorities is to make sure injured employees and beneficiaries obtain benefits in a timely and accurate manner,” said Commissioner of Workers’ Compensation Ryan Brannan. “I am pleased to see that claimants received monies owed to them. However, I am concerned there may be other deserving claimants in the same situation. These results indicate that we need to continue these types of performance audits.”

The primary focus of these performance audits was to ensure compliance with Labor Code §408.081 which provides that an insurance carrier must pay income benefits accurately. The proper calculations of average weekly wage, LIBs, and DBs are detailed in Labor Code §§408.041, 408.161, and 408.181, and in 28 TAC §§128.1, 128.3, 131.2, and 132.1.

Common compliance errors discovered in these performance audits that contributed to the underpayment of benefits included:

  • Failure to pay 75% of average weekly wage
  • Failure to obtain a complete wage statement
  • Failure to properly calculate average weekly wage
  • Failure to include non-pecuniary wages in average weekly wage

The TDI-DWC conducts performance audits every year and a list can be found at http://www.tdi.texas.gov/wc/pbo/index.html#ai .  For more information on performance audits, please contact Darrell Cooper at 512-804-4768 or Darrell.Cooper@tdi.texas.gov.



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Last updated: 02/10/2015

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