State News : Texas

NWCDN is a network of law firms dedicated to protecting employers in workers’ compensation claims.


NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.  


Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.


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Texas

STONE LOUGHLIN & SWANSON, LLP

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Death investigation professionals aka last responders must have a powerful lobby.  DWC adopted rule amendments that take effect January 29, 2026 to implement Texas Labor Code Section 504.057 which requires expedited medical benefits and accelerated medical dispute resolution for claims for medical benefits by a “death investigation professional” who sustains a serious bodily injury in the course and scope of employment, and requires that the death investigation professional inform DWC and the independent review organization that a contested case hearing or appeal involves a death investigation professional. 
 
When the legislature enacts laws that provide preferential treatment for such a narrowly defined class of injured workers, it can cause more problems than it solves with increased regulatory complexity, among other things.  We recommend doing a study in a year or two to see how many times these new “last responder” rules are invoked.  Let us know your prediction!       
 

Copyright 2026, Stone Loughlin & Swanson, LLP 

DWC announced that its 2026 initiatives include online medical fee dispute submissions, remote interpreters for CCHs, a pilot program to explore the use of AI-based interpretation tools, and use of AI for a customer service knowledge base.
 
If you haven’t spotted the trend yet, the watchword here is “AI,” the use of which is gradually encroaching on the practice of law, as it is in so many other fields.  For all AI’s benefits, there is reason to worry about his increasing presence.
 
AI has the capacity to invent facts and create information that does not exist to support its response and/or to appease the perceived bias of the user. One well-known example is of a lawyer who sued Colombian airline Avianca several years ago, alleging that a food and beverage cart injured his client’s knee while he was onboard a flight. The lawyer submitted a brief using ChatGPT to do his legal research, but the AI tool invented case law entitled Martinez v Delta Air Lines, Zicherman v Korean Air Lines, and Varghese v China Southern Airlines. When Avianca’s attorneys informed the judge that they could not locate the cases cited, the plaintiff’s lawyer had to ‘fess up and admit he had used ChatGPT. He said he asked ChatGPT to cite its sources and AI responded that the cases could be located in the Westlaw and LexisNexis databases. The judge ultimately sanctioned the lawyer and his law firm.

Likewise, our firm has received communications from opposing attorneys who have relied extensively on AI programs to generate their correspondence, a great deal of which proved to be incorrect.  Citations to the Texas Labor Code and Texas Administrative Code are often out-of-date, or otherwise non-existent.  Case law and Appeals Panel Decisions have similarly been misinterpreted and misquoted.  It has been our experience that checking and correcting AI-generated documents often offsets the supposed time saved in relying on it in the first place.

AI as a tool for collating data remains in its infancy, and as with any infant, it requires constant supervision.  While there are benefits to its use, there are substantial risks, too, and for that reason it is the policy of this firm not to rely on it in any capacity.

Copyright 2026, Stone Loughlin & Swanson, LLP

At the DWC Quarterly Stakeholder Meeting held on January 21, 2026, the DWC reported on their 2025 accomplishments and their plans for 2026.
 
Online Tools
 
New online tools introduced by the DWC over the last year include: 

  • A nifty benefit estimator tool that even includes a calculator for estimating the average weekly wage when there are multiple employers: Benefits Estimator
  • An E-File online reporting tool for non-subscribers - Employer E-File - where employers can report workplace injuries, illnesses, and deaths. The too also allows non-subscribers to file, save, and manage annual notices online.  
  • A searchable database for all kinds of interesting claims data collected by DWC:


Copyright 2026, Stone Loughlin & Swanson, LLP

Commissioner of Insurance Cassie Brown retired after more than four years overseeing the Texas Department of Insurance. Governor Greg Abbott appointed Amanda Crawford in her stead to oversee the department, for a term set to expire on 2/1/27. Ms. Crawford was serving as the executive director of the Department of Information Resources and is Texas’ chief information officer. It remains to be seen if and how the change in leadership at TDI will impact DWC since it is technically a division within the Department of Insurance.
 
In ALJ news, Barham Richard has joined the DWC as a traveling Administrative Law Judge based out of Austin. Mr. Richard has an extensive background serving as legal counsel for the Texas Commission on Environmental Quality, Lone Star Legal Aid, and the Texas Office of Public Utility Counsel. He most recently served as a Senior Staff Attorney for the Texas Medical Board. We are glad to have him join us in the wonderful world of workers’ compensation!
 
Congratulations are also in order to Christina Figueroa, Sarah Hart, and Avery Fortenberry, all of whom have been recently promoted from PROs to BROs. We look forward to working with them all during our Benefit Review Conferences.

Change is also afoot in Lubbock, where the DWC is searching for a new home for its offices and seems set on giving up its lovely quarters at 22 Briercroft Office Park.  For those who have never made the attempt, trying to locate the Lubbock Field Office for the first time is something of a right-of-passage hazing ritual among system participants, obscured as it is behind trees and secreted away along the side of the building.  Hopefully the new location is a bit more conspicuous!


 
Copyright 2026, Stone Loughlin & Swanson, LLP

Workers’ compensation insurers just secured a major victory in the Texas air ambulance litigation.  On January 16, 2026, the State Office of Administrative Hearings (SOAH) issued decisions in the two major groups of air ambulance cases pending at SOAH.
 
In both cases, the Administrative Law Judges (ALJs) found that for the years in issue from 2011 – 2013, fair and reasonable reimbursement for the base rate ranges from 128.8% to 139.3% of Medicare and the mileage rate ranges from 119.1% to 128.8%.  The ALJs rejected the air ambulance providers’ proposed reimbursement that ranged up to more than 500% of Medicare for the average total rate. SOAH previously rejected the air ambulance providers’ argument that the federal Airline Deregulation Act (ADA) preempts the “fair and reasonable” reimbursement standard and therefore, they should be paid their full billed charges.
 
The decisions issued by SOAH in these cases are notable for the depth of their analysis, each over a hundred pages, which followed a four-day hearing in the first case and a three-day hearing in the second case, both with numerous expert and fact witnesses.  Texas Mutual, which has around a 40% market share, should be commended for doing the heavy lifting in these cases.
 
The air ambulance providers, which are private equity-owned, will likely appeal these latest SOAH decisions in their ongoing effort to extract more money from the Texas workers’ compensation system.
 
As of December 2025, there are 2,183 air ambulance disputes at DWC, dating back to at least 2014, and this number will continue to rise as the air ambulance providers file new disputes.

Copyright 2026, Stone Loughlin & Swanson, LLP


Thomas Howell HIGHT JR.
 
Thomas Hight, Jr., an Administrative Law Judge at the Dallas field office of the Texas Department of Insurance, Division of Workers’ Compensation, passed away on August 19, 2025.

He was widely regarded as one of the Division’s most knowledgeable ALJs. More important than that, he was a kind and gentle soul. He will be greatly missed.

Copyright 2025, Stone Loughlin & Swanson, LLP

Predicting the Future is Too Often a Swing-and-a-Miss - Connecting the Dots

  

This month DWC published a proposed rule amending Rule 130.102 concerning eligibility for Supplemental Income Benefits. But those of you hoping that DWC would put some teeth in the rule to require a SIBs applicant to prove that he made a genuine effort to find work will be sorely disappointed. It has about as many teeth as our snuff-dipping granny.

The impetus: The proposed revision appears to be in response to a decision from the Austin court of appeals in Texas Dep’t. of Ins., Div. Workers’ Comp. v. Accident Fund Ins. Co. of America, et al., in which Accident Fund, represented by SLS, challenged the validity and applicability of parts of the rule. In that case, the insurance carriers argued that SIBs applicants who claim to be looking for work on their own (without going through a vocational rehabilitation program or requesting the assistance of the Texas Workforce Commission), cannot qualify for SIBs merely by making “work search contacts” (which can be emails or telephone calls) but, instead, they must submit actual job applications to prospective employers. A Travis County district court ruled for the carriers and enjoined DWC from awarding SIBs to applicants who make only work search contacts, and the court of appeals affirmed that injunction. As a result, DWC saw the need to revise its rule.

The new rule is an improvement: The new rule proposed by DWC would require a SIBs applicant to document a work search with job applications submitted. And it would clarify that “job application” means “a physical or electronic form or other document that is submitted to an employer . . .” so that an applicant could not claim that he submitted a job application if he merely called a business by telephone and asked if they are hiring.

But it could be so much better: The proposed rule would not require a SIBs applicant to provide the insurance carrier with a copy of the job application he submitted so that the carrier can verify that he submitted a complete application. It would not require a SIBs applicant to cooperate with a prospective employer that asks to set up an interview. And it would not require a SIBs applicant to apply only for jobs that the applicant has a reasonable chance of being able to perform given his education, skills, and functional limitations.
 
Why it matters: The current SIBs rule does not work. Too many claimants abuse it as a hand out, not a hand up. If DWC adopts the new rule as proposed, little, if anything, is likely to change. Those claimants will continue to “go through the motions” to obtain SIBs rather than making a genuine effort to find work. They will continue to submit job applications that are not completely filled out, they will continue to ignore any invitations to interview, and they will continue to apply for jobs that they have no earthly chance of being able to perform with the sole purpose of satisfying the requirements of the rule. And DWC will contribute to their dependency on SIBs by ordering carriers to pay them, quarter after quarter after quarter.

There’s still hope: But there’s still time for DWC to come through. This is just a proposed rule. DWC is requesting oral and written comments at a public hearing on the rule on October 1, 2025, and it will continue to accept written comments until October 6, 2025. SLS will be submitting written comments and we urge other system participants to do the same. Together, let’s urge DWC to revise the rule so that it supports claimants who demonstrate that they are truly trying to find work -- but not those who don’t.

Copyright 2025, Stone Loughlin & Swanson, LLP 


Earthquakes: Facts about why the Earth moves | Live Science
 


The legal landscape in Texas is changing as Texas judges begin to apply the Supreme Court of Texas’ holding in University of Texas Rio Grande Valley v. Oteka, which the Court issued in June.

Flashback: In Oteka, the Court addressed the circumstances under which DWC has exclusive jurisdiction to determine whether a worker was in the course and scope of employment at the time of an injury. The case arose after Rita Oteka, a nursing professor at the university, voluntarily attended a commencement ceremony. Afterward, as she was walking to her car, a vehicle driven by a university police officer struck and injured her.

The university, which is self-insured for purposes of workers’ compensation, reported the injury to its claims administrator which denied the claim asserting, among other things, that Oteka was not in the course and scope of her employment. Oteka did not challenge that denial or file a workers’ compensation claim. Instead, she sued the police officer for negligence.

The university asserted the affirmative defense that recovery of workers’ compensation benefits was Oteka’s exclusive remedy because the injury was related to her work.  Oteka asserted that the injury was not work-related because she voluntarily attended the ceremony and had already left when she was injured.

The parties filed cross-motions for summary judgment on the exclusive remedy defense, but before the trial judge could rule on the motions the university’s claims administrator reversed course and sent a letter to Oteka explaining that her injury had been accepted as compensable and benefits would be paid. Then the university filed a plea to the jurisdiction, arguing that DWC had exclusive jurisdiction to determine whether Oteka was injured in the court and scope of her employment. The trial judge denied the plea to the jurisdiction and the court of appeals affirmed. The supreme court also affirmed and held that DWC does not have exclusive jurisdiction to determine whether an injury occurred in the course and scope of employment when (1) the issued was raised by the employer’s affirmative remedy defense and (2) the employee’s lawsuit does not hinge on entitlement to workers’ compensation benefits.

Where we are now: Now that Texas judges are applying the holding in Oteka, they are reaching some surprising outcomes. One such surprise is a procedural ruling in favor of the injured worker in B & T Dependable Services, LLC v. Santos.
That case arose when Edward Santos, a landscape worker for B & T, finished his work for the day and then jumped into the bed of B & T truck that was towing a trailer carrying B & T equipment.  During the ride, Santos fell out of the truck bed and was run over by the trailer.
 
B & T reported the injury to its workers’ compensation carrier, Texas Mutual Insurance Company, which began paying workers’ compensation income and medical benefits. Santos accepted those benefits, which totaled more than $663, 894. He even applied for eight separate quarters of Supplemental Income Benefits and represented in each application that B & T was his employer. Nevertheless, Sanchez sued B & T for negligence, asserting his district court pleadings that he was not B & T’s employee but was, instead, an independent contractor.

B & T and Texas Mutual filed a plea to the jurisdiction and a motion for summary judgment arguing, among other things, that the suit was barred by the exclusive remedy provision of the Texas Workers’ Compensation Act. The trial court denied the plea to the jurisdiction and the motion for summary judgment. The court of appeals affirmed, citing Oteka, and held that DWC did not have exclusive jurisdiction to determine whether Santos’ injury occurred in the course and scope of employment for B & T. It said “although Oteka is factually distinguishable, it is legally guiding . . . in this case, just like Oteka, Santos’ [district court] claims are not based on his entitlement to benefits.”
                           
Copyright 2025, Stone Loughlin & Swanson, LLP 

 

On July 24, 2025, the Texas Eleventh Court of Appeals in Eastland reversed a judgment awarding an old law claimant $750,000 in “bad faith” damages from his workers’ compensation insurance carrier plus attorney’s fees of $75,950.
 
Donald Bristow was permanently paralyzed in a motor vehicle accident in 1990.  Bristow’s claim is considered an “old law” claim because he was injured prior to January 1, 1991 when the new workers’ compensation law took effect.  Therefore, Bristow’s claim is governed by the law that was in effect prior to 1991.
 
In 1993, Bristow and his workers’ compensation insurance carrier, Sentry Insurance, entered into a compromise settlement agreement that included a provision that Sentry would pay Bristow $3,650 per month for Bristow’s ongoing home health care.
 
This case began in 2018 when Sentry Insurance filed a motion to terminate its obligation to pay Bristow for home health care services on the grounds that he no longer needed the services.  Bristow brought counter-claims against Sentry for bad faith claim handling and violations of the Texas Insurance Code. 
 
In 2022, a Nolan County jury awarded Bristow $250,000 in mental anguish damages and $500,000 in additional damages under the Texas Insurance Code.  Sentry appealed the trial court’s judgment partly on the basis that Bristow’s claims are barred by the Texas Supreme Court’s 2012 holding in Texas Mutual Insurance Company v. Ruttiger. 
 
In Ruttiger, the Texas Supreme Court held that the new workers’ compensation law “prescribes detailed, [DWC]-supervised, time-compressed processes for carriers to handle claims and for dispute resolution” and that it contains “multiple, sometimes redundant but sometimes additive, penalty and sanction provisions for enforcing compliance.”  Therefore, the new law “effectively eliminates the need for a judicially imposed cause of action.”
 
Bristow argued that Ruttiger is limited to new law claims and that a 2016 decision holding otherwise from the 14th Court of Appeals in Houston was wrongly decided.  That case was In Re Illinois Employers Ins. of Wausau (Wausau II).
 
However, the Eastland Court followed Ruttiger and Wausau II and held that Bristow’s statutory and bad faith claims are barred.  The Eastland Court explained that it is the date of the alleged misconduct, not the date of the injury that dictates the applicability of Ruttiger.  You can read the Eastland Court’s decision here.
 
Bristow can petition the Texas Supreme Court to review the Eastland Court’s decision but it may be less likely to hear the case due to its limited impact since it has been over 34 years since the last old law claim.


Copyright 2025, Stone Loughlin & Swanson, LLP 


The Texas Supreme Court in Ruttiger based its decision to eliminate the common law cause of action for “bad faith” claim handling in workers’ compensation partly on the detailed enforcement process provided to DWC in the new workers’ compensation law. 
 
DWC takes that responsibility seriously as we can see from a review of this month’s disciplinary orders.  DWC issued 17 disciplinary orders in July with all but one against an insurance carrier.  The largest fine against a carrier in July was $51,000 (Disciplinary Order 2025-9389). 
 
To determine the fine amount, DWC considers a number of aggravating factors.  For example, in Disciplinary Order 2025-9393 DWC found the following factors to be aggravating:
 
  1. The violations are serious, involving $ in late medical benefits, income benefits, travel reimbursement, and attorney fees. Further, Respondent did not comply with the interest payment obligation in File No. 36758 until it received notice of enforcement action. Also, Respondent’s failure to comply with six DWC orders is a priority investigation under Tex. Lab. Code § 402.0235;
  2. Respondent has a history of 195 administrative violations since , including 54 violations involving attorney fees, medical bill payment,• and travel reimbursement;
  3. A penalty is necessary to deter future violations considering Respondent has had 195 administrative violations since ;
  4. Respondent received an economic benefit from the prohibited acts to the detriment of multiple system participants; and Respondent is the 11th largest workers’ compensation insurance carrier in Texas and has a heightened awareness of the legal duty to comply with the Texas Workers’ Compensation Act and DWC rules.
 
For carriers that are slow learners, it can be costly.  Therefore, we recommend perusing DWC’s disciplinary orders as one of the best ways for system participants to learn what to do and what not to do.
 
The takeaway here is that we can all learn a lot from “Ruttiger”: https://youtu.be/1S2D431Gbks?si=Ft1jyZU9oCfLWCeU

Copyright 2025, Stone Loughlin & Swanson, LLP

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