Texas: 32 workers’ comp carriers high performing

In its initial assessment of workers’ compensation carriers and providers, the Texas Department of Insurance Division of Workers’ Compensation found that 32 out of 147 insurance carriers reviewed were high performers.

The 147 insurance carriers in the initial assessment included 89 commercial carriers, three state entities, 43 self insureds and 12 certified self-insureds.

As part of the Performance Based Oversight (PBO) process required by House Bill 7 from the 79th Legislature, insurance carriers were assessed on their performance for the timeliness of medical bill processing, the timeliness of payment of initial Temporary Income Benefits (TIBs) checks and for how frequently they prevailed when disputes were resolved at Contested Case Hearings.

In addition to the 32 high performing insurance carriers, 96 were found to be average performers and 20 were rated poor performers.

The agency reviewed a total of 325 health care providers, rating them on their administrative duty of filing the DWC Form-69, Report of Medical Evaluation Form, in a timely manner. Health care providers were not assessed on the quality of care provided to injured employees in the PBO process.

Of the total, 101 health care providers were high performers, 159 health care providers were average performers and 65 health care providers were poor performers.

TDI-DWC said it will focus its regulatory oversight on the poor performers, as well as develop incentives within each tier that promote greater overall compliance and performance.

More information regarding PBO is available on TDI-DWC’s Web site at: www.tdi.state.tx.us/wc/pbo/pbo.html.