Texas Workers’ Comp Division Releases Disaster Guidelines for Insurers

August 31, 2017

The Texas Department of Insurance – Division of Workers’ Compensation has issued guidelines for insurers concerning workers’ compensation claims filed by insureds in counties named in Gov. Greg Abbott’s Hurricane Harvey disaster proclamation.

TDI-DWC said that for the duration disaster proclamation, insurance carriers must provide or continue to provide:

  • Processing and delivery of benefit checks and necessary medical care, services, and supplies, including physical therapy, pharmaceutical benefits, and medical equipment,
  • Waiver of penalties and restrictions related to necessary emergency and non-emergency health care provided out-of-network,
  • Coverage of payment for necessary emergency and non-emergency health care services obtained out-of-network,
  • Extended deadlines for medical examinations,
  • Authorize payment to pharmacies for up to a 90-day supply of any prescription medication, subject to the remaining number of days authorized by the prescribing provider, for individuals regardless of the date upon which the prescription had most recently been filled, and
  • Expedited change of address processing.

For system participants who reside in the counties listed in the governor’s disaster proclamation, the Texas workers’ compensation deadlines for the following procedures are tolled through the duration of the governor’s disaster proclamation:

  • Workers’ compensation claim notification and filing deadlines
  • Medical billing deadlines
  • Medical and income benefit payment deadlines
  • Electronic data reporting deadlines
  • Medical and income benefit dispute deadlines.

DWC recognizes that first responders are currently on the front lines of this disaster, helping their fellow Texans. Political subdivisions should keep in mind under the Texas labor code both DWC and political subdivisions must accelerate and give first priority to an injured first responder’s claim for workers’ compensation medical benefits if that first responder sustains a serious bodily injury in the course and scope of employment.

The Office of Injured Employee Counsel has a designated First Responder Liaison, Yolanda Garcia, who can be reached at 512-804-4173 or FirstResponderHelp@oiec.texas.gov.

Source: TDI-DWC

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