Forty workers’ compensation insurance carriers out of 120 assessed in Texas scored high enough to be placed in the “high performer” tier in a study recently released by state workers’ comp regulators.
The Texas Department of Insurance, Division of Workers’ Compensation (DWC) in its 2020 Insurance Carrier Performance Based Oversight (PBO) assessment looked at the performance of 120 insurance carriers in five measures:
- paying initial temporary income benefits;
- processing initial medical bills;
- processing requests for reconsideration of medical bills;·
- submitting initial payment data by electronic data interchange (EDI); and
- submitting medical bill processing data by EDI.
DWC reviewed 120 insurance carriers with the following results: 40 had scores placing them in the high performer tier, 76 were in the average performer tier, and four had a score placing them in the poor performer tier.
2020 Insurance Carrier Tier Assessments System Results
|Measures||Number of Insurance Carriers||High Tier Performers||Average Tier Performers||Poor Tier Performers|
|All insurance carriers were assessed on the same measures||120||40||76||4|
This was the first PBO cycle using the new methodology which places greater emphasis on the timely initial payment of temporary income benefits. This assessment also took place when changes to business operations were being made in response to COVID-19. DWC recognizes these changes may have affected PBO outcomes for certain insurance carriers.
System Results PER Measure
|Measures||Measure Weights||High Tier Performers||Average Tier Performers||Poor Tier Performers|
|Timely payment of initial Temporary Income Benefits||50% weight||25||72||23|
|Timely submission of Initial Payment data via EDI||5% weight||60||46||14|
|Timely processing of initial medical bills||30% weight||115||5||0|
|Timely processing of request for reconsideration medical bills||10% weight||70||43||7|
|Timely submission of medical bill processing data via EDI||5% weight||109||9||2|
The 2020 PBO assessment results and a list of the insurance carriers that were reviewed are posted on the TDI website. If an insurance carrier is not listed, they were not assessed in 2020; however, no insurance carrier in the Texas workers’ compensation system is exempt from compliance with the Texas Labor Code and DWC rules.
The data time frame used to assess performance of the insurance carriers for the above measures was Jan. 1, 2020, through June 30, 2020.
DWC will assess health care providers separately in 2021.
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