Update on Texas Division of Workers' Compensation Activities

By Stuart D. Colburn, Shareholder, Downs Stanford, PC

Access to Information

This Fall the Division plans to implement an online program allowing stakeholders access to a variety of statistical information regarding the workers’ compensation system without having to file open record requests.

Sunset Review

The Division of Workers’ Compensation drafted its self-evaluation for Sunset Review.  The legislative report is expected to include a possible change of the benefit structure for catastrophic injuries.

EBilling and Medical Records

The current proposed eBilling rules limit documentation carriers receive for purposes of paying a medical bill.  The Commissioner admitted some justification is required so long as it is narrowly focused.  However, he threatened carriers with administrative violations for requiring medical records with eBills.  Some healthcare providers and/or clearinghouses do not want to supply the medical records due to limitations in their software systems.  Carriers are concerned they would pay for medical treatment that is not reasonable and necessary or related to the compensable injury if they do not have access to the medical records.

Workplace Fatalities

The Commissioner cited a temporary increase in death claims in 2007 and wishes to focus on workplace safety, especially on industries at risk such as transportation and construction.

Contested Case Hearing Continuances

The 2004 Sunset Review process is fresh on the mind of the Division.  The Division is adamant about maintaining performance measures.  To that end, the Commissioner reinstated his desire to shorten the time period between the Benefit Review Conference and the Contested Case Hearing decision and order.  The Division has instructed Hearing Officers to only grant continuances if there is truly good cause.  He encouraged more discovery and exchange of materials prior to a Benefit Review Conference.

Enforcement

PBO results indicate most carriers are average with respect to timely payment of income and medical benefits.  DWC wants better results.  Expect greater enforcement measures against carriers who fail to abide by payment time frames of medical and income benefits.  Improvements should include quicker resolution enforcement.

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