Workers' Compensation Updates
and News   

Member Notification of Alliance Procedures for Employee Change of Treating Doctor

Effective immediately, an injured employee is allowed an initial choice of treating physician and one change without approval within the first 60 days of treatment.  Thereafter, any request to change treating doctors must be approved by the handling adjuster.  Amendments have been made to the following documents/forms to reflect this new requirement:

Please make sure that your employees are aware of this change and that you begin utilizing the new documents immediately.

 

TDI Issues 2010 Workers' Compensation Network Report Card Results

Since 2007, the Texas Department of Insurance (TDI) has issued an annual network report card to help employers and employees make informed decisions about the quality of services provided by networks and to help health care professionals assess the quality of the network they participate in. The Political Subdivision Workers’ Compensation Alliance (Alliance), the entity used to seek and maintain medical provider contracts for five political subdivision risk pools including the TASB Risk Management Fund, was included in the 2010 TDI network report card.

The 2010 report card, published September 30, 2010, reflects the results of a total of 47,340 injured workers treated by network entities during the study period of June 1, 2008 through May 31, 2009.  The Alliance had the second largest number of workers treated: 10,148.  The largest group was Texas Star, the network used by Texas Mutual Insurance Company, with 19,086 workers treated.

The Legislature requires TDI to compare networks to non-network claims on a variety of measures:

  • Health care costs
  • Utilization
  • Satisfaction with care
  • Access to care
  • Return-to-work
  • Health outcomes

The Alliance scored better than all other networks in this report card with the following results:

  • The Alliance’s average medical costs were lower than non-network costs in 10 of the 19 categories
  • The average Alliance medical cost for professional services was $458 compared to the non-network average of $446
  • In-patient average costs per claim for the Alliance were $19,882 compared to $22,129 for non-network claims
  • The Alliance was lower in physical therapy costs compared to non-network claims
  • Alliance spinal surgery costs were lower than non-network costs
  • Alliance average utilization rates were lower than non-network rates in 12 of the 18 categories.  The utilization measures represent services that were billed by health care providers, regardless of whether those services were ultimately paid by insurance carriers.
  • Injured workers who received care through the Alliance reported higher or equal levels of receiving needed care when compared to non-network injured workers
  • Alliance injured workers reported the highest overall levels of satisfaction with their care
  • Injured workers from three networks (Alliance, Corvel, and Travelers) reported higher return-to-work rates than non-network injured workers
  • Alliance injured workers had higher physical and mental functioning scores and than non-networks

To access the entire 2010 report card, click here.

DWC Return to Work Reimbursement Program Does Not Apply to Political Subdivisions

On 4/1/2010 the Division of Workers’ Compensation (DWC) adopted amendments to existing and new rules regarding the Return to Work Reimbursement Program for Employers.  This program was originally a pilot with the purpose of reimbursing small employers (50 employees or less) for workplace modifications that were necessary to enhance an employee’s ability to return to work after an injury.  The recent rule changes made the Return to Work Reimbursement Pilot Program for Small Employers permanent. They also increased the amount an employer could receive from the program from $2,500 to $5,000, and added an optional advance of funds plan to the program.  Unfortunately, Labor Code Section 413.022, which governs these rules, specifically excludes political subdivisions from participation in this program.  It is doubtful that the provisions of this legislation will change in the next legislative session, but we will be watching.

Fund Designated as a "High Performer" again on the DWC Performance-Based Oversight (PBO) Audit  

The Division of Workers' Compensation (DWC) at the Texas Department of Insurance (TDI) conducted its bi-annual PBO audit this year. Below are the results for data submitted as of April 2010. 

The audit revealed the Fund's overall score of 97.97% rendering High Performer (pdf) status.

  • The Fund scored 97.6% for timely payment of income benefits
  • A score of 96.14% was received for timely submission of initial payment data
  • Scores of more than 99% were received for timely payment of medical bills and data transmission.

For this PBO assessment, DWC evaluted the TASB Risk Management Fund's performance in the following areas:

  • Timely payment of initial temporary income benefits (TIBs)  - 40% weight.
  • Timely processing of medical bills - 40% weight.
  • Timely submission of initial payment data via electronic data interchange (EDI) - 10% weight.
  • Timely submission of medical bill processing data via EDI -10% weight.

For specific questions about the results, contact Sarita Shipe at 800.482.7276, extension 7221.

New to Workers' Compensation?  

If you are new to workers' compensation and/or want claim form filing information, go to our WC Basics page to get started and check this page regularly to ensure you have the most up-to-date information.

Political Subdivision Workers' Compensation Alliance (the Alliance)

The Alliance is in full swing and many service areas have been implemented.  You can get information on TASB RMF Member Alliance procedures or go to the PSWCA Web Site to find treating doctors and additional details on which service areas are up and running.  

DWC News, Web, and Resources

The DWC Home Page has a wealth of information for all system participants, from current Division Initiatives to DWC Meetings. If you want employer-specific resources, go to the Employers section to get started.

If you are looking for DWC updates, be sure to check out the "What's New" section of their site. You can also go to the DWC Web Site and add the following links to your favorites.