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Texas Department of Insurance
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February 3, 2021

Division of Workers' Compensation announces performance based oversight results

The Texas Department of Insurance, Division of Workers' Compensation (DWC) has released the 2020 Insurance Carrier Performance Based Oversight (PBO) assessment. For 2020, insurance carriers were assessed on their performance in five measures:

  • paying initial temporary income benefits;
  • processing initial medical bills;
  • processing requests for reconsideration of medical bills;
  • submitting initial payment data by electronic data interchange (EDI); and
  • submitting medical bill processing data by EDI.

This was the first PBO cycle using the new methodology which places greater emphasis on the timely initial payment of temporary income benefits. This assessment also took place when changes to business operations were being made in response to COVID-19. DWC recognizes these changes may have affected PBO outcomes for certain insurance carriers.

DWC reviewed 120 insurance carriers with the following results: 44 had scores placing them in the high performer tier, 76 were in the average performer tier, and four had a score placing them in the poor performer tier.

The 2020 PBO assessment results and a list of the insurance carriers that were reviewed are posted on the TDI website. If an insurance carrier is not listed, they were not assessed in 2020; however, no insurance carrier in the Texas workers' compensation system is exempt from compliance with the Texas Labor Code and DWC rules.

More information on PBO and the 2020 assessment are available on the TDI website. DWC will assess health care providers separately in 2021.

Last updated: 2/3/2021