Judge Rules Against TWCC in Insurance Council of Texas Lawsuit

The Insurance Council of Texas reported that on Feb. 24, 2005, Travis County District Court Judge Suzanne Covington ruled in favor of ICT in its lawsuit against the Texas Workers’ Compensation Commission.

The court decided that Rule 133.309 was invalid as it did not provide the disputing parties with their statutory right to appeal the agency’s decision to the State Office of Administrative Hearings and did not comply with the intent of the Texas Legislature as expressed in House Bill 3168. The court permanently enjoined the enforcement of the rule.

Rule 133.309 was TWCC’s effort to implement Rep. Helen Giddings’ HB 3168. That bill provided TWCC with the authority to establish, by rule, an alternate medical dispute resolution process for retrospective medical necessity disputes where the disputed billed charges are less than $650. Disputes involving more than $650 will continue to be resolved by the IRO procedures.

TWCC adopted the rule over the objections of a coalition of system stakeholders led by ICT. Prior to the adoption of the rule, the stakeholders had asked TWCC to add language to the rule that provided the disputing parties with the right to appeal the agency’s decision to SOAH as provided for by Sec. 413.031 of the Texas Labor Code. TWCC refused to provide for a right to appeal as requested by the system stakeholders.

On Sep. 24, 2004, Kevin Lee and Jay Thompson of Thompson Coe Cousins & Irons L.L.P. represented ICT in filing the suit against TWCC. At a hearing in Travis County District Court regarding our request for an injunction, the court granted a Temporary Restraining Order that blocked the implementation of the rule, pending a decision on the merits to enjoin the rule permanently.

Subsequent to the issuance of the TRO, ICT was joined in the lawsuit by Texas Mutual Insurance Company, the Texas Property & Casualty Insurance Guaranty Association, and Envoy Systems, an independent review organization certified by the Texas Department of Insurance.

Given that the statutory language is permissive, it is not known if TWCC will re-propose the rule with the appeal language included, file an appeal to the Austin Court of Appeals, or take no action at all.