TDI: New Protections for Injured Employees

Austin, TX (WorkersCompensation.com) - The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is working on rules to enact new legislation that prevents injured employees from getting surprise medical bills after receiving treatment at federal military facilities.

DWC asked lawmakers to look at the issue after seeing an increase in complaints from injured employees who were billed for medical care at Brooke Army Medical Center (BAMC) in San Antonio, a Level 1 trauma center.

Because of conflicting state and federal guidelines, some workers’ compensation insurance carriers applied state guidelines to deny bills, or only paid a portion of the charges. Since federal law requires military treatment facilities to collect reimbursement of all billed charges, the remaining balance of bills was sent to the injured employees. After 90 days, many debts were turned over to the Department of Treasury for federal debt collection, and many times injured employees’ tax refunds or Social Security benefits were garnished.

“When our data showed that injured employees were being billed thousands of dollars for services they received, a red flag went up,” said Texas Workers’ Compensation Commissioner Cassie Brown. “The basic premise of workers’ compensation insurance coverage in Texas is that injured employees receive benefits at no cost for compensable injuries, and in return, employers are protected from most lawsuits.”

Senate Bill 935 requires workers’ compensation insurance reimbursement rates for medical care provided at a federal military treatment facility to be the same rate provided by federal regulations. It also clarifies that medical care provided at these facilities is exempt from certain state workers’ compensation requirements involving billing and preauthorization.   

DWC is developing new rules to ensure these requirements are implemented.

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