Austin, TX – The Division of Workers’ Compensation (DWC) recently announced the results of the fifth Insurance Carrier Performance Based Oversight (PBO) assessment.
A total of 116 insurance carriers were reviewed. Of those, 47 were deemed high performers, 68 were deemed average performers, and 1 was deemed a poor performer.
Based on the PBO assessment, insurance carriers are placed into regulatory tiers: poor performers, average performers, and consistently high performers. The DWC will focus its regulatory oversight on the poor performers, as well as other incentives within each tier that promote greater overall compliance and performance.
Insurance carriers were assessed on the timeliness of:
- payment of initial Temporary Income Benefits (TIBs);
- processing of initial medical bills;
- processing of request for reconsideration medical bills;
- submission of initial payment data via Electronic Data Interchange (EDI); and
- submission of medical bill processing data via EDI.
The DWC is required to monitor system participants’ compliance with the Texas Workers’ Compensation Act and DWC rules and to correct noncompliant behavior. Compliance objectives are achieved through 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 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 Texas Department of Insurance website . 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 DWC rules.
Health care providers will be assessed separately in 2015.
Source: TDI-DWC