Texas Assesses Performance of Comp Carriers, Providers

The Texas Department of Insurance Division of Workers’ Compensation (TDI-DWC) announced the results of the initial review of workers’ compensation insurance carriers and health care providers as part of the Performance Based Oversight (PBO) process as required by House Bill 7, 79th Legislature.

Section 402.075 of the Labor Code requires the TDI-DWC to assess the performance of insurance carriers and health care providers, at least biennially, in meeting the key regulatory goals, established by Commissioner of Workers’ Compensation Albert Betts, for the workers’ compensation system.

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. The agency reviewed a total of 147 insurance carriers during the PBO process. Of the total, 32 insurance carriers were high performers, 96 insurance carriers were average performers and 20 insurance carriers were poor performers.

Health care providers were assessed 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. The agency reviewed a total of 325 health care providers during 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 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.

Source: TDI-DWC