December 15, 2017

TDI-DWC Announces Insurance Carriers Performance Based Oversight Results

Austin, TX – The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) recently announced the results of the fourth Insurance Carrier Performance Based Oversight assessment.

A total of 110 insurance carriers were reviewed. Fifty six carriers were deemed as high performers; 53 carriers were deemed average performers and one carrier was deemed as a poor performer.

Based on the PBO assessment, insurance carriers are placed into regulatory tiers: poor performers, average performers, and consistently high performers. The 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.

Insurance carriers were assessed on the timeliness of:

  • medical bill processing,
  • payment of the initial Temporary Income Benefits (TIBs) check,
  • reporting medical billing data, and
  • reporting the initial payment of TIBs to the TDI-DWC.

The TDI-DWC is required to monitor workers’ compensation system participants’ compliance with the Texas Workers’ Compensation Act and TDI-DWC rules and to correct noncompliant behavior. Compliance objectives are achieved through Performance Based Oversight (PBO), data monitoring, complaint handling, entity audits, and when appropriate, enforcement actions. As part of the overall compliance plan, Section 402.075 of the Texas Labor Code mandates the TDI-DWC to, at least biennially, assess the performance of insurance carriers and health care providers.

The results of this assessment and a listing of the assessed insurance carriers are posted on the TDI website: TDI-DWC Performance Based Oversight.

Not all insurance carriers are assessed and placed into a regulatory tier. This does not imply that those insurance carriers are exempt from compliance with the Texas Labor Code and TDI-DWC rules.

Health care providers will be assessed separately in 2013.

Source: TDI-DWC

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