System Monitoring and Oversight
System Monitoring and Oversight consist of three different program areas (Performance Based Oversight (PBO) and Monitoring & Analysis, Complaint Resolution and Audit & Investigations) which encourage fair treatment of system participants and the prompt delivery of benefits payments.
- Performance Based Oversight (PBO) and Monitoring & Analysis
- Complaint Resolution
- Audit & Investigations
Performance Based Oversight System (PBO) and Monitoring & Analysis
Performance Based Oversight (PBO) monitors system participants' compliance with the Texas Labor Code and Rules. PBO objectives are achieved through monitoring electronic and paper data, complaint handling, entity audits, and enforcement actions. PBO encourages and rewards excellence and continuous improvement; fosters improved and timely communications; establishes performance objectives, measures and expectations and focuses on results rather than prescriptive requirements.
- Learn More About PBO
- 2016 Insurance Carrier PBO Assessment | 2014 Insurance Carrier Assessment Results
- 2015 Health Care Provider PBO Assessment | 2013 HCP Assessment Results
Monitoring and Analysis (M&A) monitors complaints, disputes, the quality and quantity of system participants' data submissions. M&A's objectives are achieved through monitoring of electronic data submitted to the Texas Department of Insurance, Division of Workers' Compensation.
Insurance Carrier Quarterly Meetings
Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) holds quarterly insurance carrier meetings to discuss complaints and other compliance issues in the workers' compensation system.
The purpose of these meeting are to provide insurance carriers with early notice of complaint issues currently impacting the system and to solicit feedback that will assist the TDI-DWC in resolving these issues. Our goal will be to provide system complaint information and to problem-solve through focused, open communication in an informal atmosphere.
- 10/14/2015 agenda (pdf), presentation
- 7/29/2015 agenda (pdf), presentation
- 1/22/2015 agenda (pdf), presentation
- 10/23/2014 agenda (pdf), presentation
- 7/10/2014 agenda (pdf), presentation
- 4/24/2014 agenda (pdf), presentation
- 1/22/2014 meeting canceled
- 10/23/2013 agenda (pdf), presentation
- 7/23/2013 agenda (pdf), presentation
- 1/24/2013 agenda (pdf), presentation
Complaint Resolution seeks to encourage communications and assists Texas workers' compensation system participants in resolving complaints. In this process, the staff examines complaints for compliance with the Texas Labor Code and DWC Rules and makes referrals to the Audit and Investigation section of System Monitoring and Oversight when appropriate. The complaint resolution process routinely results in additional claims payments to system participants.
- File a complaint related to a WC system participant
- CY 2015 Complaint Information
- CY 2014 Complaint Information
- CY 2013 Complaint Information
- CY 2012 Complaint Information
- CY 2011 Complaint Information
- CY 2010 Complaint Information
Audits & Investigations
Audits & Investigations conducts compliance and performance audits of workers' compensation system participants and prepares justified complaints for enforcement action within the Texas Labor Code and DWC Rules.
- Audit Plan FY2016
- Audit Plan FY2015
- Audit Plan FY2014
- Audit Plan FY2013
- Management Response (Microsoft Excel Templates)
For more information contact:
Last updated: 11/03/2015