The Texas Division of Workers’ Compensation is taking a promising pilot program statewide to help simplify and speed resolution of some disputes.
A pilot started last year splits up related claim issues so that a hearing officer can decide the most far-reaching issue first. This can clear the way for secondary issues to be resolved sooner. So far, about half of the disputes accepted for the program have had a hearing, and a third of those have resulted in full agreement to resolve the dispute.
Workers’ Compensation Commissioner Ryan Brannan said he is encouraged by the outcomes.
“The division has a number of tools in its toolkit to manage claims disputes,” Brannan said. “The two-step approach to deciding some of the most complex issues in a dispute can be a good option for system participants in certain cases.”
When an injured employee has a dispute about a claim, it often involves three issues: extent of the injury, the date that the employee reached maximum medical improvement, and the impairment rating for the injury. Deputy Commissioner for Hearings Kerry Sullivan said even though extent of injury is a “threshold issue” that can affect the other issues, it was addressed at the same time as the other issues in the dispute process.
“It can be very challenging to come into a hearing and know there are so many alternatives for the hearing officer to address,” he said.
Parties in a dispute may base their recommendations for impairment ratings and dates of maximum medical improvement on what they think the extent of injury should be. If the hearing officer decides a different extent of injury, parties often request more time to adjust those recommendations.
The program is voluntary. The option to participate is presented by the presiding officer at the initial benefit review conference for cases that may benefit from the approach. The two-step approach is used only if both parties agree to it.
“The presiding officer usually knows going into the dispute whether a decision on extent of injury will move things along,” Sullivan said. “Deciding the extent of injury issue first can lead to a better outcome, a more efficient hearing, and more agreements.”
Dallas-Fort Worth area attorney Daniel Morris, of the Morris Law Firm, said several of his clients who are injured employees have opted to have their disputes handled under the two-step approach. He said there is a benefit to examining issues separately.
“When you’ve got four or five different combinations of possibilities for the extent of a worker’s injuries, it allows everybody to weigh their options before getting to the other issues,” Morris said.
Jeremy Lunn, who represents insurance carriers for the Silvera Law Firm in Dallas, said he agreed that some proceedings are slowed as attorneys try to guess what a hearing officer will decide on the extent of injury issue.
“This is a good thing that the division is trying to deal with delays in certain cases,” Lunn said. “DWC management really has been reaching out to attorneys and asking us to help it work.”
The two-step program started at the division’s Weslaco office in May 2015 and soon was expanded to Dallas. It’s now available at all 20 offices statewide.
Source: Texas Department of Insurance
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