PCI Supports Legislation to Reform Workers’ Comp System in Texas

February 16, 2005

  • February 21, 2005 at 6:55 am
    S. Meyers says:
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    I agree the TWCC has done only a poor job of protecting workers and employers from delays, inexpensive, quick dispute resolution and high costs. However, I disagree with the authors explanation that the main cause is on the doctor side.
    The author states
    “Over the past few years, perhaps the biggest problem with the Texas workers compensation system has been abuses in the delivery of medical care. This has resulted in Texas having the highest per injury medical costs and one of the worst return-to-work outcomes in the United States.”
    I believe, based upon my personal experience, that much of the problem comes from TWCC rules that allow insurance companies to improperly and many times unethically delay/deny care for patients in need which inadvertantly runs up the cost( and frustration level of all involved)by creating more chronicity in injuries unnecessarily.
    Further I believe a simple solution would be a peer review/RME system where doctors were not employeed by the insurance companies directly.
    The eligible peer review/RME doctors would be selected randomly from a pool. This would ensure a fair unbiased 2nd opinion on preauthorization and retrospective reviews as well as clean up the RME system. There would be less arguing because these docs would make their opinion based upon the facts and objective findings instead of blindly denying care so the insurance co. will send them more reviews.
    This is how the DD, PMRE & IRO opinions are supposed to work so why not make them objective from the 1st step.
    Ban insurance comanies from practicing
    medicine without a licence, as well as, hiring one they can control.This will make all our jobs much easier and save the system time and money.
    We all know there is some insurance abuse and that hurts all the stakeholders in the system but its slef ferving for we insurance people to blame most of the abuse on the providers. We need to look in the mirror. Most abuse, in fact, most insurance fraud is committed by the carriers. This is done all in the quest to save money by unehtically denying care.



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