The Texas Workers' Compensation System never stands still—and neither do we. Each month, we sort through the latest Appeals Panel decisions, regulatory changes, and industry developments to bring you the updates that matter most. Our goal is simple: provide practical insights that help claims professionals make informed decisions, reduce risk, and confidently manage claims.

Stay informed, sharpen your skills, and earn CE credit with our monthly Lunch & Learn series. Each session is designed to provide timely updates, practical insights, and real-world strategies on issues affecting workers’ compensation professionals. You'll leave with valuable knowledge you can put to work immediately—and receive continuing education credit for your participation.

The first 25 adjusters to sign up will be in the course. Once you have registered, you will receive confirmation for the Webinar. The Zoom link will be emailed the Monday before each Webinar. Please note that if you have taken the course before in the last two years, you will not be eligible for credit again per 28 Texas Administrative Code Section 19.1010(7)(c).

Join us on July 10, 2026, from 12:00 P.M. to 1:00 P.M. to discuss: Subsequent Injury Fund (SIF) with Adrienne J. Gasser and Kara E. Squier.

The Division of Workers' Compensation has been relatively quiet this month, but don't get too comfortable.

Significant developments are on the horizon, and we'll break down everything you need to know in our July issue—including what the changes mean for claims professionals and how they may impact your claims handling.

Stay tuned—you won't want to miss it!

DECISION

A DD ruled in favor of the injured worker on five out of the eight conditions in accordance with the DD’s report. The AP affirmed. The pro se IW sought judicial review. The court granted the IC’s no evidence MSJ. The IW failed to respond to the MSJ or provide any evidence, including expert medical evidence, that would support her contention the three conditions were caused by her injury.

DECISION

Several teachers were injured and some died on a Mexico immersion trip. They recovered a significant sum in a third-party case against Toyota. The IC sought subrogation recovery for total income and medical benefits paid, including $350,000 it paid in a settlement with the health insurance carrier. The plaintiffs sought and received the trial court’s approval of apportionment of the settlement fees without a trial or even a contested hearing that did not include the $350,000. The court held the trial judge erred when finding no reimbursement for the $350,000 in health care without an adjudicated hearing and ignoring the uncontroverted evidence of the monies spent. The court held the trial judge can protect both parties’ interests while suggesting the plaintiffs and their lawyers received funds unlawfully.

DECISION

The IW was a long-haul truck driver and the owner of his own company who argued his AWW should include the amount he was paid prior to deducting his own expenses. The AP writes, "In the instant case, the claimant's AWW should be based on his net profits. To disregard his business expenses in calculating his AWW would lead to an unjustifiably inflated AWW figure, a figure far higher than the economic advantage he gained by working."

DECISION

The plaintiff was injured while working at a client’s plant. He alleged at the negligence trial that he was under financial stress and could not procure medical benefits. The court allowed the defendant to cross-examine the IW about his workers’ compensation benefits concerning payment of medical expenses. The collateral source rule generally precludes evidence of benefits received by the plaintiff from someone else. An exception applies when a plaintiff claims financial hardship. Further, there was no error since the plaintiff was not seeking past medical damages, the only type of damages the collateral source rule related in this case.

DECISION

The ALJ found the RME’s certification was invalid on its face and therefore did not become final. The DWC-69 and the narrative report indicate the RME exam took place on May 8, 2025. But the certification is dated May 7, which was a typographical error. The AP held the RME certification meets the three elements of validity. The MMI date of March 3 is not prospective because it occurs before the May 8 date of certification.

DECISION

The claimant was living with his mother before the injury. He subsequently moved but did not report the change of address to his employer or the IC. The IC sent the PLN-3b and DWC-69 by verifiable means to the only address they knew. This address was used by the employer to send paycheck stubs during this same time period. The AP reversed holding the IC properly mailed the PLN-3b to the address on record.

DECISION

At a previous CCH, the ALJ found the IW was not at MMI. The ALJ in the current CCH found the first subsequent certification after the first CCH did not become final because it was not the first in time certification. The AP reversed noting the preamble and rule allows the first subsequent certification to become final.

Author: Stuart D. Colburn

The Division of Workers’ Compensation (DWC) continues to emphasize the importance of timely payment of income benefits to injured employees. Violations are being issued when carriers do not pay benefits weekly, including impairment income benefits (IIBS).

As you all know, a carrier must pay benefits weekly, as and when the benefits accrue, without order from the DWC.

An employee’s entitlement to IIBS begins on the date after the employee reaches maximum medical improvement (MMI) and, when the date of MMI is not disputed, the carrier shall initiate payment of IIBS on or before the fifth day after the date of receipt of the medical evaluation report.

Each week a carrier fails to timely pay IIBS following the receipt of the medical evaluation report it is a violation and the DWC will not hesitate to issue a monetary penalty against the offending carrier.

Make sure to take notice any time a report, including a DWC-69, is received which shows the employee has reached MMI and is given an impairment rating entitling the employee to IIBS.

Most Employers need to be constantly reminded to file their DWC-6s whenever there is a change in post-injury return to work or post-injury earnings.

The DWC-6, Supplemental Report of Injury, is meant to be prepared by the Employer as a supplement to the DWC-1, Employer’s First Report of Injury, in order to advise the Carrier how much they should be paying in TIBs.

The Division requires the reporting of all fluctuations in return to work and post-injury changes in earnings on this form.

The DWC-6 will state the amount of Post-Injury Earnings, which is deducted from AWW to allow Carriers to determine the amount of lost wages.

Unfortunately, most employers do not timely file DWC-6s, which causes the amount of Post-Injury Earnings to not be timely deducted from the lost wages.

While the Division Rules state that an Employer who fails to timely file a DWC-6 commits an administrative violation, the Division rarely pursues violations for this.

As a consequence, the claimant gets overpaid TIBs because Post-Injury Earnings do not end up getting deducted timely, or at all, from the amount of lost wages.

As attorneys for Carriers, we love having the DWC-6s available for use at a CCH because they can rebut a claimant’s testimony that he "hasn’t earned any wages since the injury" since the DWC-6 will reflect the date he began losing time, or the date he returned to work light-duty, whether he earned his pre-injury wages or earned reduced pay, or the date he was terminated or resigned, and the reasons for the termination or resignation.

Author: D. Rynn Freiling

At Downs & Stanford, P.C., we remain committed to helping our clients stay ahead of emerging issues, manage risk effectively, control claim costs, and navigate the workers’ compensation system with confidence.

Send your questions to Q&A.

For Employer’s Liability, General Liability, Subrogation, and all other areas of law, email questions here.

Want some CE credit?  Come and get it!  Join us for Lunch and Learns every second Friday of the month.  For information and registration, email CE Department.

Have questions about Designated Doctors, RMEs, or Peer Reviews or have records for a DD, RME, or Peer?  Email our DD Department.