TX DWC Announces Performance Based Oversight Results For Insurance Carriers

Insurance carriers were assessed on their performance with timeliness of medical bill processing, timeliness of payment of the initial Temporary Income Benefit (TIBs) check, timeliness of reporting medical billing data, and timeliness of reporting initial payment of TIBs to TDI-DWC.

Health care providers will be assessed separately in 2011 with final results expected to be announced in late 2011. 

TDI-DWC is required to monitor workers' compensation system participants' compliance with the Texas Labor Code and TDI-DWC rules and to correct noncompliant behavior.  Compliance objectives will be achieved through PBO, data monitoring, complaint handling, entity audits, and when appropriate, enforcement actions. 

Section 402.075 of the Texas Labor Code mandates TDI-DWC to, at least biennially, assess the performance of insurance carriers and health care providers in meeting the key regulatory goals established by the Commissioner of Workers' Compensation.  The key regulatory goals align with the general regulatory goals of TDI-DWC such as improving workplace safety and return-to-work outcomes, supporting timely payment of benefits and increasing communication with system participants.

Based on the PBO assessment, insurance carriers were placed into the three regulatory tiers: poor performers, average performers, and high performers. TDI-DWC will focus its regulatory oversight on the poor performers, as well as offer incentives within each tier that promote greater overall compliance and performance.

The results of this assessment and a listing of the assessed insurance carriers are posted on the TDI website www.tdi.state.tx.us/wc/pbo/pbo.html. The omission of an insurance carrier's name from the most recent list of PBO assessments does not imply that an insurance carrier is exempt from compliance with the Texas Labor Code and TDI-DWC rules.

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