Fund’s Workers’ Compensation program assessed by Division of Workers' Compensation: Tops in performance

by Herman Wilks

When the 79th Legislature set the lofty goal for Texas Workers’ Compensation (WC) under House Bill 7 (HB 7), an overhaul of the entire system was the order of the day. Although the sweeping changes of HB 7 have been well-documented, one of the critical successes of its implementation is to grade the performance of both carriers and health care providers. As a result, Texas Labor Code Section 402.075 was created, which requires the Texas Department of Insurance, Division of Workers’ Compensation (DWC) to conduct performance-based oversight (PBO). Specifically, DWC is required to:

• Assess the performance of carriers and providers at least biennially
• Develop regulatory tiers distinguishing high, average, and poor performers
• Develop incentives to include public recognition of high performers and to sanction poor performers

After more than a year of poring through collected data, attending stakeholder meetings, and conducting studies to determine the best method of implementing an appropriate PBO process, DWC published a summary in June 2007 to be reviewed for final assessment. The Fund was ultimately assessed based on data collected by DWC for calendar year 2006 using the following methodology:

• Timeliness of medical bill processing, which carried a weight of 45 percent of the final score
• Timeliness of the initial payment of Temporary Income Benefits (TIBs), which also carried a weight of 45 percent of the final tally, and
• The ratio of total Contested Case Hearings (CCH) in which the carrier prevailed. This constituted the final 10 percent of the overall score.

Not all WC carriers were selected for the inaugural PBO assessment. DWC chose the top 147 carriers based on the volume of initial payment of TIBs transactions electronically submitted in calendar year 2006. The overall tier assessments for carriers indicated that 21.8 percent (32 carriers) scored in the High Tier, 64.6 percent (95 carriers) were in the Average Tier, and 13.6 percent (20 carriers) scored in the Poor Tier.

DWC published its final results of the PBO regulatory process in August. The Fund received a final performance based score of 97.5—one  of the highest performers in the industry. The Fund received high marks in all areas, including a 99.3 in the timeliness of medical bill processing. 

The Fund's overall mission has always been to provide innovative, aggressive, and affordable programs for all of its members. Being recognized as an industry leader while serving the needs of its members demonstrates the Fund’s continuous dedication to providing quality service.

Read more information about PBO.