Austin, TX – The Texas Department of Insurance, Division of Workers’ Compensation (DWC) has released results of the 2016 Insurance Carrier Performance Based Oversight (PBO) assessment. For 2016, insurance carriers were assessed on their performance for timeliness in the following categories:
- payment of initial Temporary Income Benefits;
- 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.
Of the 115 insurance carriers reviewed: 42 had scores placing them in the high performer tier, 70 were in the average performer tier, and three had scores placing them in the poor performer tier.
The results and a list of the insurance carriers included in the 2016 PBO assessment are posted on the Texas Department of Insurance website. If an insurance carrier is not listed, it was not assessed in 2016; however, no insurance carrier in the Texas workers’ compensation system is exempt from compliance with the Workers’ Compensation Act and DWC rules.
Information regarding PBO and the 2016 assessment is available on the TDI website. DWC will assess health care providers separately in 2017.