We're glad to see you are interested in becoming a policyholder owner with us. Texas Mutual works with licensed agents to provide workers' compensation coverage to businesses across the state. We recommend working with an agent that you trust, and oftentimes, an agent who helps you with other business insurances can obtain a quote from us. We look forward to providing you a quote and amazing service.
If you need help finding an agent, complete our form, and we'll help you connect with one.
Employers who choose to get a Texas Mutual workers' compensation policy become part owners of the company. Our success is shared financially with our policyholders through our decades-long dividend program.
Texas Mutual needs a written request signed by the policyholder or an authorized representative of the company and a completed ACORD 130 from the new agent to change the agent on an active policy or quote.
The request should not be more than 30 days old and should include:
Requests can be sent by:
If you didn't receive an invitation, you can self-register by clicking the link below. You'll need your FEIN and policy number, along with some basic information.
You can reset your password. You can also give us a call at (800) 859-5995 or email firstname.lastname@example.org and we can help you get access to your account.
If it is a true emergency, you can send your employee to the emergency room. For non-life-threatening injuries, and for policyholders who are enrolled in the health care network, your employees must get treatment from network physicians. We recommend using the Find a doctor tool to locate a physician in our health care network who specializes in workers' compensation care.
You should report all on-the-job injuries to Texas Mutual the same day they occur, if possible. The law allows employers up to eight days to file the Employer's First Report of Injury or Illness; however, the sooner you report the injury to us, the sooner we can help you with the claim.
If you do not file an initial report of injury within the eight-day period, you waive the right to reimbursement for voluntary payments.
Call us at (800) TX-CLAIM (892-5246)
Fax: (877) 404-7999
Mail: Texas Mutual Insurance Company, Attn: Claims; P.O. Box 12029; Austin, Texas 78711-2029
Watch how to report an injury to Texas Mutual.
A DWC-3 is an Employer's Wage Statement. It's outlined by the Texas Department of Insurance, and Texas Mutual uses it to calculate how much financial assistance an injured employee is eligible for. Your adjuster will let you know if you need to complete a wage statement.
If you are enrolled in our health care network called WorkWell, TX, your employee must see an in-network doctor for their work-related injuries or illnesses. If it is a true emergency, your employee should get immediate care and can seek treatment at the nearest emergency room, if necessary.
WorkWell, TX is comprised of high-quality physicians who specialize in treating workers' comp injuries and illnesses. We recommend using our network physicians, even if you are not enrolled. Your employee should let the medical office know it is a workers' comp injury or illness and that Texas Mutual is their workers' comp insurance provider.
We partner with Optum to help ensure that your employee gets the prescriptions they need.
Our First Fill Program (English PDF, Spanish PDF) allows injured employees to get the prescriptions they need even before a claim has been filed with Texas Mutual. Learn more about our pharmacy benefit manager or call the Optum help desk at (833) 4U-OPTUM, (833) 486-7886.
If you have an Other States policy, you can report injuries that occur outside of Texas directly to Argonaut Insurance by:
Visit Argonaut to view Other States claims kits, which give specific information about reporting for each state.
We encourage you to report these injuries directly to Argonaut, but you can also report them to Texas Mutual at (800) TX-CLAIM (892-5246).
A workers' compensation health care network is a group of health care providers that have contracted with an insurance carrier to provide care to its members. The network consists of treating providers, hospitals, specialty providers and other health care professionals. Health care providers in the network have met the network's quality of care standards.
Workers' compensation health care networks are designed to:
If employers choose the network option, their injured workers must seek treatment from network doctors. Network doctors have unique experience in treating workplace injuries. They use their expertise to treat injured workers and get them back on the job as soon as medically reasonable.
To help you save on your claim costs and improve return-to-work outcomes, Texas Mutual offers the WorkWell, TX health care network. This network, which provides a 12% network discount, is made up of high quality doctors who are experienced in treating workers' compensation injuries and illnesses. You have the option to enroll in the health care network during the quoting process. If you opt in the network, that means your employees must see a network provider if they are injured on the job.
If employers choose the out-of-network option, your injured employees can seek treatment from the WorkWell, TX network or any doctor who will treat them under the Texas Workers' Compensation rules.
The WorkWell, TX network was built with you in mind. Texas Mutual has sourced the highest quality providers who are experienced in occupational medicine and share our commitment to getting your workers back to a productive life.
In WorkWell, TX, you can expect quicker return to work, a better experience for you and your employees, and lower claims costs. Employers who enroll in the network will also receive a 12% network discount.
Employees receive care from doctors and specialists who have extensive experience treating occupational injuries and illnesses. The network’s focus is on directing employees to the right providers while allowing them to maintain choice by selecting their doctor from those in the network.
Let your agent know you are interested in joining the network. You do not have to wait for your policy to renew. We encourage you to consult your insurance agent to decide whether the network is the right choice.
Network participation comes with responsibilities for employers.
Texas requires that at the time of network selection or within three days of new employee hire and at the time of injury, employers must provide employees with a notice of network requirements. The notice must be in English, Spanish or any other language common to employees. It must include a list of network providers, a notice that the employee must see a treating doctor that is in the network, and an explanation of the complaint process.
In addition to delivering the notice, employers must obtain a signed acknowledgment form from employees at the time of notice and the time of injury. Employers must establish a standardized process for delivering the notice. Keep a record of how, when, where and to whom you delivered it, which you can do with our acknowledgement log. If an employee refuses to sign the acknowledgment, he or she will still be required to comply with the terms of the network if the employer fulfills his responsibility and maintains a record of delivery.
If an employee has not received the notice at the time of injury, they may not be obligated to network requirements until notice is provided, and they may seek care from any provider who is licensed to practice in Texas. Texas Mutual will reimburse the provider for medical care delivered in accordance with the Texas Department of Insurance, Division of Workers' Compensation fee guidelines and will begin the process of transferring the claim to the network.
Employees who meet the following conditions must seek care within the network:
If the employee meets these conditions, he or she must select a treating doctor from the doctors offered by the network in their service area. If the employee does not seek care within the network, he or she may be responsible for payment to non-network medical providers.
Employees are entitled to one change of treating doctor within the network. Any subsequent requests to change a treating doctor must be approved by the network.
Employees may seek treatment from their HMO doctor, if the HMO doctor will accept the network's terms and conditions. This provision does not apply to preferred provider organization (PPO) plans or family doctors. Employees who select their HMO primary care physician as their treating doctor should inform Texas Mutual.
In addition to the ability to treat with their HMO doctor, employees may go outside the network:
Note: Credit card payments are not accepted at this time.
Eligible employers can sign up for autopay after coverage is bound and you've created your Texas Mutual Online account. Log in to your account and access the billing screen; then choose Set up autopay. With your permission, we'll draft the amount invoiced on the invoice due date from the bank account you've set up.
You can unenroll from autopay at any time.
If you're enrolled in autopay at the time of an invoice due date, the following payment types will be drafted: monthly and quarterly payments, as well as final audit payments.
At this time, policy renewal payments are not processed through autopay. Agents or employers can still make a renewal payment by check or one-time payment.
Employers who are on agency billing, have a past due balance or are on a collection payment plan are not eligible for autopay. If you have workers' comp coverage in other states, you may not be eligible for the feature at this time.
We process and bill policy changes as we receive them for our customers who pay in full or are on installment billing.
To simplify billing for our payroll reporting customers, we invoice policy changes with the final audit.
Your payment options depend on various factors such as industry. You may qualify for one of three payment options.
We charge a $10 late fee if we do not receive your payment by the due date. This is to help you keep your coverage in effect. Employers can sign up for autopay to make sure you never miss a payment. Call us at (800) 859-5995 for more information or if you have questions.
If you are unsure of how much you owe, we encourage you to log in to view your premium and any debits or credits you may have. If you have questions, you may call us at (800) 859-5995 and we'll be happy to help.
You can check current billing information in your Texas Mutual Online account. Log in to get started and select Billing/payments.
No, Texas Mutual does not currently accept credit card payments.
An employer may request reimbursement when they have paid out-of-pocket for health care provided for a compensable injury and provided notice of injury to Texas Mutual.
The employer's request for reimbursement must include:
Employers can send reimbursement requests by:
We send a certified letter to employers 60 days before a policy ends so you have time to renew. Call us with any questions at (800) 859-599 or check with your agent to see how your business can continue your coverage.
Policies may be cancelled for many reasons, such as nonpayment. We do our best to notify employers of outstanding issues that may lead to cancellation, as well as offer a period when employers can make changes to prevent cancellations. If you would like your policy reinstated, you can work with your agent or call us with any questions at (800) 859-5995.
Contact your agent to request a certificate of insurance.
Payroll reporting is assigned to businesses in industries that frequently have fluctuating payrolls. This payment plan allows you to make a deposit on a policy, report your payrolls as you go and pay premium based on actual payrolls for that reporting period, rather than paying the estimated annual premium in full. This helps ensure you pay for the right amount of coverage.
You can submit a payroll report online through your Texas Mutual account.
Workers' compensation premium is based on payroll, and some businesses have a higher amount of fluctuating payroll based on their type of work. Payroll reports help ensure that the amount you pay in premium is as accurate as possible throughout the life of your policy term.
We will still need a record of your payroll. You can follow the same payroll reporting process and enter zeroes. We may follow up with you to clarify why there was no dollar amount entered.
Regular overtime pay (time and one-half) is calculated at 66.6%. For example, $100 of regular overtime is reported as $67.00 of gross payroll. Double-time pay is calculated at 50%, so $100 of double-time pay is reported as $50.00 of gross payroll.
Visit Create an account to register. You'll need your FEIN and policy number, along with some basic information.
You can make corrections by adding notations on a copy of the submitted report and returning it to us by email or fax. For timely processing, do not try to resubmit the report through the online system.
Follow these steps:
You’ll see the revised report within 7 days in your account.
Endorsement activity may have occurred on your policy, which could have altered your rates. Premium discounts only apply to policies annualized with a total earned premium over $5,030 and increase upwardly according to premium. Contact your agent or call us at (800) 859-5995 for more information.
If your agent has provided you with a class code and instructed you to do so, specific instructions are included in the event you should require an added class code when reporting. The online system will require the four-digit number for the class code and a detailed description of the change in operation and/or duties of the individual under the new code.
These change requests are subject to underwriting review and audit. If the class codes are not applicable, the proper class code will be used at final audit. If you do not know a class code number or rate, we suggest that you contact your agent.
For compliance purposes, whether final cancelled or expired, we request that you submit your report and payment. NOTE: You cannot report online if a final audit has been completed on your policy. Contact your agent for re-submission requirements if your policy has been final cancelled. If you have additional questions, call us at (800) 859-5995.
We will apply and adjust your deposit after we complete your policy's final audit. If you fail to make a payment with your reports, you risk possible cancellation of your current coverage.
Try again later or call us at (800) 859-5995. To avoid possible delays that may lead to interruption in coverage, we suggest that you make your payments using the automatic check debit option. Otherwise, please include your policy number and bill period information on your check, and mail prompt payment to: Texas Mutual Insurance Company, P.O. Box 841843, Dallas, Texas, 75284-1843.
No. Online payments must be paid in full. Payroll reporting is a form of a payment plan, since full annual deposits are not required up front on payroll reporting. If you begin online reporting during a policy period, there may be a debit or credit balance from previous reports.
We suggest that you submit and pay your last report period, as this was the condition in which your policy was issued. If you are positive that the deposit will cover the last report, please comment as such when submitting the last report. If the deposit will only cover a portion of the last report, a partial payment is due. We request that you print your receipt and send in the partial amount due to deter any audit balances.
Yes, you must submit your reports on time to avoid a possible lapse in coverage. If you report zero payroll for a given reporting period, you must send supporting details with your report. Some instances require an endorsement to cover an officer, owner, or partner if zero payroll is consecutively reported.
If actual payroll is submitted on each report, adjustments can be made at audit. An alternative method is to divide the required amount by the number of reports that will be submitted and report a portion on each report. Another alternate method is to report the required flat or maximum amounts on consecutive reports, and cease after the maximum, minimum, or flat amount has been fully reported. This will lessen or eliminate additional premium after audit if these amounts need to be charged.
Online payroll reporting provides directions for you to request an address change when you submit your payroll report online. We also advise you to share your new address with your agent as soon as possible.
If you are a leasing company, we encourage you to submit your reports and payment online. As is the case with paper reporting, online reports can only be done for client companies that are included or endorsed onto the policy at the time of the reporting period. New clients cannot be submitted on your report, as they require underwriting review and endorsement. As such, we suggest that you request client additions as soon as possible to ensure coverage and to report and submit accurate premium on your reports.
Your policy will go into pending cancellation status if reports and payments are not submitted by due dates. If a new client is not endorsed before the due date of the report period, it is requested that you submit and pay online for the client companies that are on the policy or have been endorsed.
You will need to submit a revised report manually and make payment, for the new client only, immediately after it is endorsed. This will need to be sent to: Texas Mutual Insurance Company, Attention: Interim Unit, 2200 Aldrich St, Austin, Texas 78723-3474.
If you are awaiting an endorsement, please contact your underwriter.
At the end of the policy period, a final audit will ensure you were charged the correct amount for the coverage provided. If an adjustment is needed, you may get some money back, owe more because your payroll grew or have no change at all.
End-of-year final audits happen online, by phone or in person. Our premium audit team is full of warm, helpful specialists who walk you through the process and make it simple and easy.
No, not all policyholders require a final audit. In fact, most policyholders with premium less than $5,000 will have their audit waived.
Since workers' compensation premium is based on multiple factors including estimated payroll for the policy period, premiums will adjust over the life of the policy. A premium audit lets us determine if you underpaid or overpaid for their premium.
If you have received a letter from us about completing your final audit online, you can log in at texasmutual.com/finalaudit. You will need the unique code provided in the letter to get started.
A premium auditor may request different types of financial records to complete their review of your estimated premium. Our appointment coordinators will let you know what they need for their audit, which may include the following:
We need these documents for each covered client such as staff leasing, PEO and temporary employment agencies, if applicable.
An auditor may also request additional records if they are needed to complete the audit. Part 5-G of your workers' compensation policy states: "These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records and programs for storing and retrieving data."
It's important to us to make sure that our audits are accurate. An audit can be disputed by submitting a dispute letter if you do not agree with the final audit findings. The dispute should include the specific reason(s) for the dispute, along with verifiable supporting documentation.
Disputes should be sent to:
If you use subcontractors, you must report the subcontractor payroll unless each subcontractor has provided you with a Certificate of Workers' Compensation Insurance, or you have obtained a signed joint agreement form establishing an independent contractor/subcontractor affirmation. We reserve the right to seek additional information to verify your relationships with subcontractors to determine whether their pay should be included in premium calculations for your policy.
In accordance to the Texas Labor Code, officers, members, sole proprietors and partners are automatically included under their company's workers' compensation policy unless they elect to exclude themselves from coverage.
Texas uses a state-specific classification code for executive officers: Code 8809 — Executive Officers NOC — Performing Clerical or Outside Salespersons Duties Only. This classification is only applicable for officers of corporations and/or members of LLCs; therefore, sole proprietors and partners are not eligible for inclusion to this classification.
An executive officer of a corporation or a member of a limited liability company may elect to exclude him/herself if they have 25% or more ownership in the business. They are classified based on their actual job duties and their premium is based on payroll, subject to a minimum/max scale ($7,800 minimum and $62,400 maximum).
A sole proprietor or general partner can elect to exclude him/herself from coverage. Sole proprietors and partners (general or limited) are classified based on their actual job duties. Their premium is based on payroll, subject to a fixed amount of $65,400 (policies written on or after October 1, 2020) or $63,100 (policies written on or after October 1, 2019). Please note that this fixed amount changes annually. Spouses of sole proprietors or partners are also automatically included under their company's workers' compensation policy, unless (like the sole proprietor or partner), specifically excluded by endorsement.
You can log back in to texasmutual.com/finalaudit with the unique login credentials (found in your final audit letter) to view your audit submissions. Your audit details can be viewed for up to 90 days after you submitted.
Yes. We will reach out if we have any questions about discrepancies.
It's very important to us to make sure we only charge what you owe. Payroll reporting is a high-level submission process, while an audit ensures that everything was coded correctly. If anything changed over the year, this will help us catch those changes and adjust your premium if necessary.
In May 2022, Texas Mutual’s board of directors approved a $330 million dividend payout. Dividends will be distributed to qualifying policyholders in late June.
Policyholders can view dividend information and amounts in their Texas Mutual Online accounts on June 24, 2022.
Those who don't have an account but wish to log in and see their dividend information should create an online account and request dividend access. Call us at (800) 859-5995 if you have any questions.
There are a lot of factors that we evaluate to determine who qualifies for a dividend. We look at your safety record and your time with Texas Mutual to determine the safety and retention components of a dividend.
If you qualify for a dividend, you will receive your check from Texas Mutual through the mail. We do not currently offer direct deposit.
Historically, we have mailed dividend checks in June.
We want to make sure you receive your dividend. Contact us at (800) 859-5995 if you need us to reissue a check.
Texas Mutual can reissue dividend checks. Call us at (800) 859-5995.
In most cases, dividends are tax exempt, but you should consult your tax professional.
Dividends are based on performance and therefore are not guaranteed. Texas Mutual has, however, distributed dividends each year since 1999.
To report suspected fraud, email email@example.com or call (800) 488-4488. Please include the following in your report:
Texas Mutual will investigate every report received. Informants can earn up to $1,000 for reporting suspected fraud.
We may wish to contact you for additional information, especially if your report involves employee (claimant) fraud. Additional information might include a description of the claimant's:
We keep all contacts and information you provide confidential. See more information below about reporting anonymously.
Workers' comp fraud may seem like a victimless crime, but it's not. All Texans pay for workers' compensation fraud through higher costs of goods and higher premiums. More than $80 billion in fraudulent insurance claims are made annually (across all insurance lines including workers' compensation).
Also, when reporting to Texas Mutual, you could earn up to $1,000 through our Fraud Stoppers program. See the below FAQ for more information.
Texas Mutual rewards those who help us fight fraud. Any person, except as restricted below, who contacts the Fraud Stoppers investigation team and gives information that leads to the arrest or indictment of any person for a crime against Texas Mutual Insurance Company is eligible for a reward of up to $1,000.
Under special circumstances, where the purpose of the Fraud Stoppers program may best be served by so doing, the Fraud Stoppers committee may approve a reward where no arrest or indictment is or can be made. The Fraud Stoppers program will pay a maximum reward of $1,000 for each solved crime against the Company that results in an arrest or indictment. There is no minimum reward. The Fraud Stoppers committee, in its sole discretion, will determine the amount of the reward depending on the importance of the information given, as determined by the committee.
If there are multiple informants, the committee will divide the reward among the informants in whatever proportions it deems appropriate, in its sole discretion. The committee's decisions are final and not subject to appeal. Informants will remain anonymous. The committee will identify each informant by assigning a code word and code number to the informant at the time of the initial contact.
The following persons are not eligible for the reward: employees or contractors of the Company or members of their immediate families; commissioned law enforcement officers or members of their immediate families; owners, officers, and managers of a Company policyholder (unless the perpetrator is the policyholder, in which case officers and managers, but not owners, are eligible); and the perpetrators of the crime.
We respect your right to remain anonymous, and we keep all contacts and information you provide confidential. However, we have found that additional contact is usually necessary to effectively investigate a case. Unless you specify that we should not contact you, our Special Investigations Department will contact you to tell you the status of our investigation.
No. If we cannot connect a fraud tip to a Texas Mutual claim or policy, we will forward the information to the Texas Department of Insurance's fraud unit.
As injured workers are receiving treatment, they can help detect health care provider fraud. Injured workers can watch for the following signs and report suspected fraud to Texas Mutual at firstname.lastname@example.org or (800) 488-4488: