Texas Finds 13% Of Comp Carriers Perform Poorly

A Texas Department of Insurance review of the state's workers' compensation insurers, based on speed of payment and other factors, has ranked 13.6 percent in the poor performance category.

The study results announced Friday, which also included health insurers, was mandated by the Performance-Based Oversight process contained in 2005 comp reform legislation that also abolished the Texas Workers' Compensation Commission and transferred its functions to the TDI's Workers' Compensation Division.

An assessment of the performance of insurance carriers and health care providers is now required at least biennially to meet key regulatory goals, established by Texas Commissioner of Workers' Compensation Albert Betts, the TDI noted.

Mr. Betts said, "We have several tools at our disposal to monitor the compliance of system participants with the Texas Workers' Compensation Act and system rules. Our compliance objectives will be achieved through the PBO process, data monitoring, complaint handling, entity audits and, when appropriate, enforcement actions."

The agency reviewed a total of 147 insurance carriers during the PBO process. Of the total, 31 insurance carriers were rated high performers, 96 insurance carriers were average performers, and 20 insurance carriers were poor performers.

Insurance carriers were assessed on their performance for the timeliness of medical bill processing, the timeliness of payment of initial temporary income benefits (TIBs) checks, and for how frequently they prevailed when disputes were resolved at contested case hearings.

Based on contested case hearing ratings for carriers, 11.6 percent fell in the poor category, 23.1 percent were in the high performance category, and 65.3 were rated average.

Rated for initial pay performance, 20.4 percent of carriers fell in the poor category, 30.6 percent were rated high performers, and 50 percent were rated average.

Evaluated for medical bill processing, 76.2 percent were rated as high performers, 22.5 percent were put in the poor category, and 1.5 percent were rated average.

Health care providers were assessed on their administrative duty of filing the DWC Form-69, Report of Medical Evaluation Form, in a timely manner.

Health care providers were not assessed on the quality of care provided to injured employees in the PBO process. The agency reviewed a total of 325 health care providers during the PBO process. Of the total, 101 health care providers were high performers, 159 health care providers were average performers, and 65 health care providers were poor performers.

TDI-DWC said it will focus its regulatory oversight on the poor performers as well as develop incentives within each tier that promote greater overall compliance and performance.

More information regarding the oversight process is on TDI-DWC's Web site at http://www.tdi.state.tx.us/wc/pbo/pbo.html.