Reynolds Urges Insurers to Get Active in Workers’ Comp Litigation Issues

Calling the medical fee guideline the most important element of the workers’ compensation legislation passed by the 77th Texas Legislature—House Bill 2600—Richard F. (Dick) Reynolds, executive director of the Texas Workers Compensation Commission (TWCC) told insurers to get involved in fighting legal challenges aimed at thwarting implementation of the guideline.

Reynolds, a former member of the Texas State Board of Insurance and a former member of the Texas House of Representatives, made the remarks at the 2002 Mid-Year Property & Casualty Insurance Symposium, held July 17 and 18 in Austin and sponsored jointly by the Insurance Council of Texas (ICT) and the Association of Fire and Casualty Companies of Texas (AFACT).

Implementation of the guideline, which was adopted in April and becomes effective Sept. 1, was challenged in a lawsuit filed in a Travis County court by the Texas Medical Association (TMA) and the Texas AFL-CIO. The guideline unreasonably cuts “reimbursements by 17 to 41 percent for surgeons, radiologists, pathologists, internists and physical medicine specialists who treat injured workers,” according to a statement released by the TMA. The group also alleges that the guideline “illegally ties workers’ compensation reimbursement to the fees that Medicare pays for similar medical services to elderly Texans.”

Reynolds, however, looks at the guideline from a different perspective. “With respect to the medical fee guideline challenge, I want to urge all of you that can participate with the employers and the TAB, Texas Association of Business, to get directly involved in this lawsuit,” Reynolds said. “This particular article—the medical fee guideline—in HB 2600 is paramount … and if it goes down, to me, we’ve got to start all over … It’ll be a disaster if we’re not able to prevail. So I urge all of you to help the TAB, to get involved with the AG’s [attorney general’s] attorneys and the TWCC attorneys.”

He asserted that bringing “medical reimbursement fees to a fair and reasonable range” and controlling litigation were the two most important aspects of HB 2600, and the only ways of effecting cost reduction or better cost control in the workers’ compensation system.

Taking aim at the TMA and its president, Fred Merian M.D., Reynolds noted that Dr. Merian has asserted that the TWCC erred in adopting federal price controls. “TMA’s Dr. Merian obviously has a problem,” Reynolds said. “TWCC did not adopt federal price controls, and the treating doctors under the new fee guideline—that’s about 8 out of 9 doctors—will have a slight enhanced fee reimbursement. There’s only selected surgical procedures that will have a decrease in the reimbursement fee.”

Commenting on a statement he attributed to Dr. Merian that the “TMA’s key objective is to improve the health of all Texans,” Reynolds said, “And I believe, also, (TMA’S objective is) to continue excessive workers’ compensation payments to a select group of orthopedic (doctors) and neurosurgeons.”

He continued: “You know, at one time I believe that TMA represented a very broad group of doctors. It appears today they represent a very small group of selected surgeons. I think what Dr. Merian is referring to when he says ‘federal price controls’ is Medicare. And as you all know, the Medicare program pumps over two billion dollars of funds into Medicare providers’ pockets annually … What is most interesting about his derogatory reference to federal price controls is that if the federal government even considered dropping their Medicare program, the first people in Washington raising Cain would be the TMA and the AMA and Dr. Merian. And they’d be lobbying hard not to do away [with] or discontinue this federal price control program.”

He noted a number of other cases under litigation he regards as important, including Downs v. Continental Casualty Co. (32 S.W.3d 260). “The Downs case has to do with the timeframe for contesting defensibility of claims,” Reynolds said. “It is on appeal at present and we may have to have a legislative fix at some time on that.”

Reynolds cited another case that he believes is one of many “interesting attempts to circumvent our system.” Describing the situation, Reynolds said, “a chiropractor in the [Rio Grande] Valley has filed 723 lawsuits and a justice of the peace order in county court in Cameron County, seeking full payment of his billed charges and to bypass our medical dispute process and our fee guidelines … Fortunately a Travis County district judge has issued a temporary injunction. Trial is set for September 30th of this year.”

Reynolds offered suggestions to legislators for actions they can take in the effort to hold down costs in the workers’ comp system. “One would be to limit chiropractic care to needed chiropractic care,” Reynolds said, adding that “one option is to make it available only on referral by an MD or DO as it is under Medicare.

“Let me give you an example of a chiropractic case that’s on my desk right now,” he continued. “A laceration on a hand of the claimant between the middle finger and the fourth finger … a laceration … the treating doctor is a chiropractor. An MD sewed up the hand and gave medication and said ‘return to work.’ The chiropractor as the treating doctor has kept the claimant off work.” Costs in the case ran up to $18,000.

Another cost-saving initiative proposed by Reynolds is to “streamline the dispute resolution process—reduce the redundant due process part and I would start with eliminating SOAH (State Office of Administrative Hearings).” He noted that TWCC has some 20,000-plus hospital fee disputes hung up in SOAH, and added: “It’s really disgusting to witness the time, effort and money being wasted.”

Topics Lawsuits Carriers Texas Workers' Compensation