Workers' Comp Action in the Lone Star State

Austin, TX (WorkersCompensation.com) - Between a bill to form a workers’ compensation fraud unit and the release of an annual study to create a more transparent, faster and preemptive system, the Lone Star state has seen some recent action in the workers’ compensation world.

HB 2053 has been passed onto the governor for signature. Points included, “create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision” according to the HB 2053 Analysis, which also included forming a type of “rulemaking authority to a state officer, department, agency, or institution.”

Hence, Texas now has a workers’ compensation fraud unit.

“The bill authorizes the division to provide technical or litigation assistance to the authority to which the division refers persons involved in a case subject to an investigation for further investigation or the institution of appropriate proceedings,” reads the analysis, adding it also increases monetary penalties due for fraud and can increase sentencing measures from a Class A misdemeanor to a felony. 

These amendments begin in September, and apply to an offense committed on or after that date. Simultaneously The Texas Workers’ Compensation Research and Evaluation Group (REG) 2017 research agenda, an outline of aiming to enhance the system for the injured worker, has been approved. According to the agenda, a group of researchers must study data relating to benefit litigation, ratemaking procedures, recovery and reemployment, medical benefit costs, employer participation and employment health and safety issues.

Ben Gonzalez with the Public Affairs Division (Media Relations) at the Texas Department of Insurance said the state has collected and analyzed data since 1989 in an effort to inform both legislative and regulatory policymaking decisions.

“REG evaluates research topics from stakeholders and elected officials, and considers them based on resources needed and the goals of the Legislature and other stakeholder groups. We get input from as many sources as possible, keep the process open to the public as we move along, and carefully track the impact on the system over time,” he said. 

The REG was under the Texas Department of Insurance and was moved to be a part of worker's compensation in an effort to create a stronger system, according to Commissioner of Workers' Compensation Ryan Brannan, who said good data was indispensable as far as the successful future of the state’s workers' compensation, in an Insurance Journal report.

This data was delivered by economist Soon-Yong Choi, research specialists Batao Shi and Conrado Garza, and workers’ compensation expert D.C. Campbell. “We’re already a model for other states, and the work of the research group has always been an important part of our efforts. We’ll continue to leverage their expertise, and take things up a notch wherever we can,” Brannan said the Insurance Journal report.

According to the Agenda, the Research and Evaluation Group will complete the below this year:

• Completion and publication of the 11th edition of the Workers’ Compensation Health Care Network Report Card
• Baseline evaluation of the utilization and cost patterns of compound drugs
• A comprehensive analysis of the income benefit adequacy of claims receiving Temporary Income Benefits (TIBs), Supplemental Income Benefits (SIBs), Lifetime Income Benefits (LIBs), and Death Benefits
• Update of 2003 study on impact of accredited and non-accredited work-hardening/work conditioning programs

Gonzalez said now that the Commissioner of Workers’ Compensation has adopted the FY 2017 Research Agenda, the REG will focus on compound drugs, income benefit adequacy, the impact of accreditation on work hardening/work conditioning programs and the 2017 workers’ compensation network report card. 

“The network report card provides policymakers and the public with trends and data on the cost and quality of medical care provided by individual networks. The network report card helps insurance carriers decide which networks to select for their policyholders,” Gonzalez said, adding TDI uses the report card to gauge whether the networks are performing adequately and to determine whether certain networks warrant more examination.

“Finally, policymakers, including DWC, use it to gauge the effectiveness of the statutes and rules that govern the delivery of medical benefits to injured employees, allowing them to streamline those rules and statues where practical,” he said.

Gonzalez said in Fiscal Year 2017, REG we’ll evaluate the use and cost patterns of compound drugs, another significant cost driver in workers’ compensation. “We expect to find opportunities to ensure quality care for injured employees and cut costs for employers there as well,” he said.

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This story was updated as of 5/31/17.

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