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Snapshot: 2020 Division of Workers’ Compensation Biennial Report to the 87th Texas Legislature

This report presents system trends that allow the Division of Workers’ Compensation, policymakers, and system stakeholders to gauge the relative health of the Texas workers’ compensation system and consider whether additional legislative changes are necessary.

Read the full report.

Published: December 2020 by the Division of Workers' Compensation.

Workers’ compensation insurance rates down 73%. 71% of private-sector employers with coverage. Texas’ non-fatal injury and illness rate down 42% since 2005. 92% of claims handled without dispute. 9% increase in total claims file in 2020 due to COVID-19.

The non-fatal injury and occupational illness rate is down 42 percent from 2005, but COVID-19 resulted in a 9 percent increase in the total number of claims filed since 2019.

Texas and U.S. Non‐Fatal Occupational Injury and Illness Rates Per 100 Full‐Time Employees, Private-Sector (2005‐2019)

Number of Workers’ Compensation Claims Reported to DWC, Injury Years 2015‐2020

Texas’ cost per claim with 12 months maturity is about 24 percent less than the median cost of the 18 states analyzed. But in 2018, in-patient hospital costs rose by about 24 percent.

Average Medical Cost for Claims with More Than Seven Days of Lost Time (All Services), 12 Months and 36 Months Average Maturity

Average Hospital Cost for Claims with More Than 7 Days of Lost Time, 12 Months Average Maturity, 2004‐2018

Today on average, injured employees are waiting half as long to get their first non-emergency medical visit as they did in 2011.

Average Number of Days from Date of Injury to Date of First Non-Emergency Treatment 2011-2020, Six Months Post-Injury

More injured employees receiving income benefits are getting back to work within six months - 83 percent compared to 74 percent in 2004. About 9 out of 10 injured employees receiving temporary income benefits (TIBs) return to work within one year of their injury.

Percentage of Injured Employees Receiving TIBs Who Initially Returned to Work at Six Months and One Year Post‐Injury

About 92 percent of claims are handled without the need for dispute resolution with DWC. Since 2015, the number of benefit review conferences (BRCs) concluded declined 18 percent, while the number of contested case hearings (CCHs) declined 9 percent.

Number of BRCs Requested and Number of BRCs and CCHs Concluded, 2015-2019

Medical necessity disputes continue to decline each year. While networks accounted for about half of all new claims in the last few years, non-network claims accounted for most of the medical necessity disputes filed (about 8 out of 10 disputes filed).

Number and Distribution of Medical Necessity Disputes by Network Status, 2014-2019

Initial data call results show that only about 35% of COVID-19 claims filed resulted in a positive test or diagnosis. Among these positive test claims, nearly half (48 percent) were accepted as work-related by insurance carriers, more than a third (38 percent) were denied by the insurance carriers, and 14 percent were still under investigation. Despite the number of COVID-19 claims that were denied, DWC’s administrative data (as of October 25, 2020), showed that there were only 10 COVID-19 claim disputes filed with DWC.

Number of COVID-19 Claims, Positive Test Claims, and Claim Disposition as of June 30, 2020, Data Call Results

Last updated: 2/4/2021