Texas Work Comp Treatment Planning Pilot Project Launched

Several Texas workers’ compensation insurance carriers are participating in a pilot project with health care providers to initiate treatment planning for workers’ compensation injuries, according to the Texas Department of Insurance Division of Workers’ Compensation (TDI-DWC).

The project began on Nov.1, 2007, and will end on Jan. 31, 2008. Participants include Texas Mutual, The Hartford Financial Services, University of Texas System and Zurich.

“The goal of this pilot project is to define a process for initiating, creating, submitting, reviewing and implementing evidence-based and functionally-oriented treatment plans,” said Dr. Howard Smith, TDI-DWC Medical Advisor.

The pilot project also will provide information concerning treatment planning that will assist TDI-DWC in rulemaking concerning treatment planning, preauthorization and/or case management.

Dr. Smith said participating insurance carriers may contact an injured employee’s treating doctor and request submission of a treatment plan when the worker has not returned to work within 60 days after an injury or when the workers’ compensation claim is not showing progress toward functional restoration 60 days after the injury. He said the participating insurance carriers have agreed to a reimbursement schedule for health care providers who prepare treatment plans.

During the pilot project, treating doctors also will be able to initiate discussions about treatment plans with participating carriers.

“The development and approval of a treatment plan is optional for both the insurance carrier and the treating doctor,” Dr. Smith said.

More information about the workers’ compensation treatment planning process is posted on the agency Web site at www.tdi.state.tx.us/wc/dm/index.html.

Source: TDI-DWC