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Workers' Comp Basics
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  • Getting started with Texas Mutual
  • Online account management
  • In case of injury
  • Health care network
  • Billing and payments
  • Policy-related questions
  • Payroll reporting
  • Final audit
  • Dividends
  • Fraud

Getting started with Texas Mutual

How do I get workers' compensation coverage through Texas Mutual?

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.

I need an agent. How do I find one?

If you need help finding an agent, complete our form, and we'll help you connect with one.

What do I need to do to bind coverage?

To bind coverage, we need a deposit payment from either you or your agent. This payment can be made online or by mail.

Make a payment

See billing and payment FAQs

What is a policyholder owner?

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.

How do I change my agent?

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:

  • Name of the new agent and their Texas Mutual agency code
  • Contact information for the new agency
  • Policyholder's signature and date
  • Effective date of the change

Requests can be sent by:

  • Email: apps@texasmutual.com (Please include "AOR" in the subject line.)
  • Mail: Texas Mutual Insurance Company, Attn: Underwriting, P.O. Box 12058, Austin, TX 78711-2058
  • Fax: (800) 359-0650

Online account management

How do I create an online account?

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.

Create an account

What do I do if I'm having trouble logging in?

You can reset your password. You can also give us a call at (800) 859-5995 or email information@texasmutual.com and we can help you get access to your account.

What can I do with my online account?

A lot! You can submit and track claims, access free safety resources, submit payroll reports (if applicable), view network and pharmacy options, check your loss runs and dividend history, as well as manage payments.

Log in

Create an account

How do I obtain loss runs?

You can download loss runs from your Texas Mutual Online account. Log in to get started, then select Loss Runs and Claims under the Claims tab.

In case of injury

Can I send my injured worker to the emergency room?

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 our Network Provider Directory by visiting texasmutual.com/care to locate a physician in our health care network who specializes in workers' compensation care.

Learn about WorkWell, TX

Do I have to report a work-related injury or illness?

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.

How do I report the injury?

To report an injury, you will need to complete an Employer's First Report of Injury form, called the DWC-1. We recommend that you log in to your Texas Mutual Online account, then select Report Injury. This will help streamline your online reporting experience by pulling in information that we already have on file. If you prefer, you may call us to report, or you can complete the DWC-1, which you can find on our Employers forms page, and submit by fax or mail. 

Report an injury

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.

...
What is a DWC-3 and how do I submit one?

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.

You can complete a DWC-3 Employer's Wage Statement online or download from the employer forms page.

How does an injured employee get medical care?

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.

Find a network doctor

Learn about WorkWell, TX

How does an injured employee get prescriptions?

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.

Find a network pharmacy

How do I report an Other States claim?

If you have an Other States policy, you can report injuries that occur outside of Texas directly to Argonaut Insurance by:

  • Phone: Call the number provided with Argonaut's policy (state-specific)
  • Online: Report to Argonaut
  • Fax: to (888) 329-3764

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).

Health care network

What is a network?

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:

  • Improve quality of care
  • Help injured workers get back on the job
  • Control medical costs

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.

What does in-network/out-of-network mean?

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.

Find a network doctor

How do I find a doctor?

If you are enrolled in the health care network, Workwell, TX, then your employees must seek treatment from an in-network physician. Use our Network Provider Directory by visiting texasmutual.com/care to find one near you. To confirm that you're a network participant, call (800) 859-5995.

Watch how to find a network doctor.

...
What doctors are in the network?

Doctors of all specialties are in the WorkWell, TX network. Use our Network Provider Directory by visiting texasmutual.com/care to find one near you.

Learn more about WorkWell, TX

Why choose the network?

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.

How do I enroll 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.

What do I need to know about enrolling in the network?

Network participation comes with responsibilities for employers.

Employer Responsibilities

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.

What are my employee's responsibilities if I enroll in the network?

Employees who meet the following conditions must seek care within the network:

  • the policyholder has purchased a policy with network coverage
  • the policyholder has provided the employee with the required notice and obtained a signed acknowledgement form
  • the employee lives within a network's service area

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:

  • if they live outside the network's service area
  • to receive emergency care
  • to visit a specialist upon the referral of their network treating doctor

Billing and payments

How can I submit a payment?
  • Online: texasmutual.com/pay
  • Mail: Texas Mutual Insurance Company, P.O. Box 841843, Dallas, TX 75284-1843
  • Overnight delivery: Texas Mutual Insurance Company, 2200 Aldrich St., Austin, TX 78723-3474
  • Wire transfer: Call Texas Mutual at (800) 859-5995 for more information
Where can I find billing information online?
  • Log in to Texas Mutual Online and select the Billing/Payments tab to view billing information, including current amounts due and billed invoices
  • New to Texas Mutual? Create a Texas Mutual Online account
Which payment methods does Texas Mutual accept?
  • Online payments, using Automated Clearinghouse (ACH) transactions, from your checking or savings account – Make a payment
  • Checks by mail
  • Wire transfers
  • Money orders and cashier's checks

Note: Credit card payments are not accepted at this time.

What is Texas Mutual's company ID number?

You can use Texas Mutual’s company ID #0000408976 to authorize online payments from your bank to Texas Mutual.

How do I sign up for autopay?

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.

What payments are processed through autopay?

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.

Why am I not eligible for autopay?

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.

How are policy changes billed?

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.

What payment plans are available?

Your payment options depend on various factors such as industry. You may qualify for one of three payment options.

  • Pay in full: You pay the estimated annual premium in full by policy effective date.
  • 12-month installment billing plan: 12-monthly installments with first payment due by policy effective date.
  • Payroll reporting: If you're in an industry where payroll tends to change a lot, you may be enrolled in a payroll reporting plan, which allows us to confirm workforce size and status as it fluctuates.
Why am I being charged a late fee?

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.

How much do I owe on this invoice?

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.

Can you confirm you received the check I mailed or my online payment?

You can check current billing information in your Texas Mutual Online account. Log in to get started and select Billing/payments.

Can you confirm you received the check I mailed or my online payment?

You can check current billing information in your Texas Mutual Online account. Log in to get started and select Billing/payments.

How do I request reimbursement for a medical bill?

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:

  • Form DWC-2 (Employer's Report for Reimbursement of Voluntary Payment), which you can find on our forms page
  • Copy of the health care provider's bill on the required billing form
  • Any supporting documentation submitted by the health care provider
  • Documentation of the payment to the health care provider

Employers can send reimbursement requests by:

  • Email: claims@texasmutual.com
  • Mail: Texas Mutual Insurance Company, P.O. Box 12029, Austin, Texas 78711-2029
  • Fax: (512) 224-3889
How do I change the email address my invoice is sent to?

To change the email address your invoice is sent to, you must update the email connected to your Texas Mutual Online account. To do this:

  • Log in at texasmutual.com
  • Select My Account
  • Edit your email adress
  • Select Apply Changes

Policy-related questions

What is an expiration letter?

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.

What is a notice of cancellation?

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.

Where can I get a certificate of insurance?

Contact your agent to request a certificate of insurance.

How do I report ownership changes?

If you have a change in ownership, you will need to report that to Texas Mutual within 90 days. Watch our microlearning to see how to complete the form and notify Texas Mutual of the change.

View microlearning

ERM-14 form

Payroll reporting

What is payroll reporting?

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.

How do I complete the payroll report?

You can submit a payroll report online through your Texas Mutual account or call (800) 859 - 5995 to request a payroll reporting form be sent by mail.

  1. Determine your gross payroll for the current payroll period

    Include: Wages, commissions and bonuses; pay for holidays, vacations or periods of sickness; rental value of housing or apartments provided for an employee, value of lodging, meals, fuel, or any other advantages; substitutes for money such as the value of a store certificate or merchandise; salary reduction plans, flexible benefit or cafeteria plans 401(k) plans.

    Do not include: Tips, payments by your company to a group insurance or pension plan, special rewards, dismissal or severance wages.

    Round to whole dollars: Round up if figure ends with 50-cents or more, and round down if the figure ends with 49-cents or less.

    Overtime wages deduction: Deduct the amount paid in excess of regular time worked (over 40 hours a week) ONLY IF your records show overtime pay separately by employee AND in summary by classification of work. Deduct one-third of the overtime pay for time-and-a-half and deduct one-half of the overtime pay for double time.

    For example: Gross payroll (includes $33 for overtime at time-and-a-half) = $100. Deduct 1/3 for overtime (-$11). Net wages for base premium calculation = $89.

    Note about subcontractors
    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.
  2. Allocate your gross payroll to the proper class code

    This will calculate your earned premium for each classification code pertaining to your operations during the reporting period.

    Our underwriting team must approve classification code additions or changes. If this request cannot be made before the payroll report is due, it is required that you provide detailed descriptions of any new operations or new employee duties when requesting a new class code. 
Why do I have to complete a payroll report?

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.

What action is needed if I do not have any payroll for this payroll reporting period?

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.

How do I calculate the deduction for overtime payroll?

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.

How do I set up an online account to submit a payroll report?

Visit Create an account to register. You'll need your FEIN and policy number, along with some basic information.

How can I make a payment for my payroll report?

You can make a payment online, or you can mail us at check. See payment options.

How do I revise a submitted report?

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:

    1. Log in.
    2. Select Payroll Reporting in the top navigation.
    3. View and print the payroll report submission that you need to update.
    4. Make the corrections. Cross out the incorrect payroll figure(s), write in the correct amount and write "Revised" at the top of the document.
    5. Email or fax this document to underwriting@texasmutual.com or (800) 359-0650.

You’ll see the revised report within 7 days in your account.

Why have my state level rates changed?

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.

Can I add a class code during reporting?

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.

What if my policy is final cancelled or final audited?

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.

Can I apply my deposit to my reports?

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.

What should I do if the payment system is down?

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.

Are partial payments accepted?

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.

Do I have to pay my last report if the deposit will cover the last reporting period?

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.

Do I have to submit a payroll report if there is no payroll to report?

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.

How do I report covered officer minimums/maximums or owner/partner flat fees?

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.

What if my address has changed?

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.

Leasing companies: How can I add new clients?

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.

Final audit

What is a final audit?

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 by phone, online, in-person or virtually. Our premium audit team is full of warm, helpful specialists who walk you through the process and make it simple and easy.

Does every policyholder have a final audit?

No, not all policyholders require a final audit. In fact, most policyholders with premium less than $5,000 will have their audit waived.

Why do I have a final audit?

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 your premium.

I'm on payroll reporting, why do I need to go through a final audit?

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.

How do I dispute final audit findings?

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:

  • finalauditdispute@texasmutual.com
  • Texas Mutual Insurance Company, Attention: Premium Audit Dispute Unit, 2200 Aldrich St., Austin, Texas 78723-3474
  • Fax: (512) 224-6785
Where do I log in to complete the final audit?

If you have received a letter from us about completing your final audit online, choose one person to be the final audit contact at your company. Once they begin, they will be the only person who can access the audit.

The contact person can log in at texasmutual.com to submit information. Once they log in, they can complete the audit using our online audit system.

If they do not have an account, they can create one online. They will need the company’s policy number and Federal Employer ID number (FEIN).

How can I check that Texas Mutual received the final audit information I submitted online?

You can log back in to texasmutual.com to view your audit submissions. Your audit details can be viewed for up to 90 days after you submitted.

What records will be requested for a final audit?

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:

  • Payroll records — Gross pay, overtime pay, tips, severance, etc. (By employee and class code)
  • Quarterly reports — State unemployment (TWC forms) or Fed 941
  • Amounts paid to subcontractors — Cash payments, written contracts, work orders, invoices, general ledger, check register, vendor reports, P&L, disbursement journal, etc.
  • Certificates of insurance — Proof of workers' compensation coverage for contractors (if applicable)
  • Owner/contractor-controlled insurance programs (OCIP, CCIP, ROCIP) — Certified payroll for jobs covered by OCIP/CCIP, certificates of insurance covering OCIP/CCIP, etc. (if applicable)

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."

If I have more than one of the supporting documents on the list, how do I determine which document to use?

Texas Mutual prefers the Texas Workforce Commission reports if you have them.

What payroll should I include/exclude?

Include:

  • Wages or salaries
  • Commissions and bonuses
  • Pay for holidays, vacations and sick leave
  • Value of any other remuneration or substitutes for pay, etc. (Total amount of wages paid before any deductions, including wages paid to employees terminated during the policy period.)
  • Payments to uninsured subcontractors that are deemed not to be independent

Exclude:

  • Tips and other gratuities
  • Employer contributions to group pension plans
  • Value of special rewards for invention or discovery
  • Severance pay (except for accrued vacation time)
  • Reimbursements for business expenses such as automobile, meals, lodging, etc.
  • Safety awards/bonuses (if approved by the underwriter at policy inception)
  • Davis Bacon Act wages (if diverted into third-party pension trust)
Should I include payroll for 1099 and non W-2 workers in my final audit?

If a 1099 or non W-2 worker provided a Certificate of Insurance, they are an independent business and you do not need to include their payroll. If they did not provide a Certificate of Insurance, they are dependent on you to provide workers’ comp coverage and you will need to provide their payroll.

Should I include payroll for subcontractors in my final audit?

If you use subcontractors, you must report the subcontractor payroll unless each subcontractor has provided you with a Certificate of Workers' Compensation Insurance, or they meet the definition of an Independent Contractor found in Texas Labor Code 406. 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.

Are company officers and owners included on the final audit?

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.

How can officers and owners be excluded from the final audit?

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).

How can a sole proprietor or a general partner be excluded from the final audit?

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 a fixed amount of $76,300 (policies written on or after October 1, 2023) or $72,300 (policies written on or after October 1, 2022). 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.

I have my 941s/TWC reports, but the payroll/quarters do not match exactly. Can I use those?

Yes. We will reach out if we have any questions about discrepancies.

Can I upload my documents online?

Yes, if your audit is conducted by phone, online, in-person or virtually, you can upload your payroll documents online.

For phone, in-person or virtual audits, you can save time by uploading your payroll documents before your scheduled audit by logging in to Texas Mutual Online (TMO). You’ll receive an email ahead of your scheduled audit with instructions on how to start uploading your documents. If you’re new to TMO, you can sign up and return to the email you received with instructions to continue uploading your documents.

Why do I need to upload my documents ahead of time?

For phone, in-person or virtual audits, we encourage you to upload your documents before your scheduled audit by logging in to Texas Mutual Online (TMO). This gives your auditor advanced time to review the documents and will speed up your time spent with your auditor.

What file types do you accept for uploaded documents?

Supported file types include PDF, XLS, XLXS, DOC, DOCX, PNG and JPG.

How many files can I upload?

The maximum file size for each file is 5MB and the overall upload limit for one session is 15MB. Once you submit your documents, you can return to the page to upload more.

Can I edit the document name?

You cannot edit a document name once it is uploaded. We recommend changing the document name on your personal computer before uploading to our system. Click the trash can symbol to delete your document and re-upload with your desired document name.

Why is my document not uploading?

First check that your document is the correct file size and document type. Next check that your internet is fast and stable. If the issue continues, call us at (800) 859-5995 and we can help.

Can I edit the documents after I submit?

You cannot edit or delete after a document is submitted. Please make sure the file you are uploading is correct before clicking Submit.

What happens after I submit?

Once you submit your documents, you will receive a confirmation email that they were successfully sent to your auditor. Please have your documents close by during your audit in case you need to resend or refer to any of the information during the review.

How can I check that Texas Mutual received the documents I submitted online?

You will receive an email confirmation outlining the submitted documents. You can upload documents for 90 days after your final audit. If you have any questions about your audit, please call us at (800) 859-5995.

Dividends

When are dividends paid?

In May 2025, Texas Mutual announced that its board of directors approved a $330 million general dividend payout. Dividends will be distributed to qualifying policyholders in late June.

How can I see if I will receive a dividend?

Policyholders can view this year’s general dividend information and amounts in their Texas Mutual Online (TMO) accounts starting June 20, 2025.

Those who don't have an TMO 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.

How do I qualify for a dividend?

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.

How will I get my dividend check?

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.

What if I need to change my address?

We want to make sure you receive your dividend. Contact us at (800) 859-5995 if you need us to reissue a check.

What if I misplace or accidentally discard my check?

Texas Mutual can reissue dividend checks. Call us at (800) 859-5995.

Are dividends tax exempt?

In most cases, dividends are tax exempt, but you should consult your tax professional.

Is the dividend program guaranteed every year?

Dividends are based on performance and therefore are not guaranteed. Texas Mutual has, however, distributed dividends each year since 1999.

Fraud

What is workers' comp fraud?

Workers' compensation fraud occurs when someone willfully makes a false statement or conceals information in order to receive benefits (claimant fraud), save money (employer fraud), or make more money (health care provider fraud). Read more about these types of fraud and what to watch for.

How do I report fraud?

To report suspected fraud, email fraudstoppers@texasmutual.com or call (800) 488-4488. Please include the following in your report:

  • Name of individual, employer, health care provider, attorney or medical facility
  • The city in which they are located
  • Reasons you suspect fraud

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:

  • Estimated height
  • Estimated weight
  • Hair color and length
  • Other distinguishing physical characteristics
  • Vehicle (approximate year, make/model, color and license plate, if possible)

We keep all contacts and information you provide confidential. See more information below about reporting anonymously.

Why should I report suspected fraud?

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.

How do informants earn a Fraud Stoppers reward?

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.

Can I report fraud anonymously?

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.

Does Texas Mutual investigate fraud unrelated to their own claims or policies?

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.

What are the signs of fraud?

Fraud can come in various forms, and with various red flags. Read more about what to watch for in terms of injured worker, health care provider and employer fraud.

If you suspect fraud, report it to us at fraudstoppers@texasmutual.com or call (800) 488-4488.

How can injured workers watch for health care provider fraud?

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 fraudstoppers@texasmutual.com or (800) 488-4488:

  • Bills or explanation of benefits for services that seem unnecessary or fictitious
  • "Boilerplate" medical reports (reports that seem standardized or appear to be copies of previously submitted reports)
  • Treatment dates on holidays or weekends for non-emergency situations
  • Bills that represent an unreasonable amount of billable hours per day
  • Billing for services or treatment never performed
  • Billing exorbitant amounts for treatment

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General: (800) 859-5995
Health care providers: (888) 532-5246

Sitemap

Privacy policy

©2025 Texas Mutual Insurance Company. All rights reserved.

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