The Texas Department of Insurance Division of Workers’ Compensation has posted on its Web site the 2009 Performance-Based Oversight (PBO) Results for workers’ compensation insurance carriers and selected health care providers.
For this PBO assessment, TDI-DWC evaluated insurance carriers’ performance in the following areas:
- Timeliness of processing medical bills
- Timeliness of submitting medical billing data electronically to TDI-DWC
- Timeliness of initiating temporary income benefits (TIBs)
- Timeliness of submitting initial TIBs data electronically to TDI-DWC
The results of carrier performance assessments were based on data obtained by TDI-DWC and any additional data provided by the carrier.
Carrier results were divided into three tiers – high performers, average performers and low performers. The average performance category contained the most number of carriers. Of the 138 insurance carriers reviewed in the 2009 PBO assessment process, 30 had scores placing them in the high performer tier, 100 were in the average performer tier, and 8 were in the poor performer tier.
High tier performers scored between 95 and 100 percent. Scores for average performers ranged between 80 and 95 percent. Low tier performers scored below 80 percent.
High tier and low tier performers are listed below. The list of average tier performers, and more information about the assessment, may be found online at http://www.tdi.state.tx.us/wc/pbo/pboresults.html#icsrslt.
High Tier Performers (Alphabetical Order)
ABF FREIGHT SYSTEM INC—————-98.59
AMERISURE INSURANCE CO————-98.00
CONTINENTAL CASUALTY CO————96.39
EAST TX EDUCATIONAL INS ASSN—-95.35
EL PASO ISD————————————97.45
FEDERATED MUTUAL INSURANCE CO-96.22
GENERAL MOTORS CORP—————-95.90
LA JOYA ISD ———————————–96.72
LOCKHEED MARTIN CORP—————95.92
McALLEN ISD ———————————-97.21
NORTH EAST ISD —————————100.00
OLD GLORY INSURANCE CO————95.37
PLANO IND.SCHOOL DISTRICT———–97.90
ROCHDALE INSURANCE CO————–95.82
SERVICE LLOYDS INSURANCE CO—–97.22
STATE FARM FIRE & CASUALTY CO —95.14
STATE OFFICE OF RISK MANAGEMEN –95.15
TASB RISK MGMNT FUND———————97.38
TEXAS BUILDERS INSURANCE CO——–96.37
TEXAS MUTUAL INSURANCE CO———–95.70
TEXAS WATER CONSERVATION ASSOC RIS -95.57
TRUCK INSURANCE EXCHANGE————95.11
UNIVERSITY HEALTH SYSTEM ————-97.09
UTICA MUTUAL INSURANCE CO————95.03
ZENITH INSURANCE CO———————–96.96
Low Tier Performers (Alphabetical Order)
AMERICAN GUARANTEE & LIABILITY INS–78.92
CITY OF CORPUS CHRISTI —————— 77.65
CITY OF MCALLEN——————————–52.03
DALLAS AREA RAPID TRANSIT————-74.80
FEDEX FREIGHT EAST INC——————–70.30
FORT BEND ISD————————————75.12
XL SPECIALTY INSURANCE CO ————79.32
Of the 274 health care providers reviewed in the 2009 PBO assessment process, 4 had scores placing them in the high performer tier, 51 were in the average performer tier, and 219 had scores placing them in the poor performer tier.
Health care providers assessed for the 2009 PBO process were assessed on their performance with timely filing the Report of Medical Evaluation Form, DWC Form-069; timely filing of the Work Status Report, DWC Form-073; and completeness of the DWC Form-073. Health care providers were not assessed on the quality of medical care they provided.
Source: Texas Department of Insurance, www.tdi.state.tx.us
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