56 Carriers Deemed High Performers in Texas Work Comp System

January 8, 2013

Texas workers’ compensation system regulators report that 56 insurance carriers have been deemed high performers in the system.

Announcing the results of the fourth Insurance Carrier Performance Based Oversight assessment Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) said out of the 110 insurance carriers reviewed, 56 were deemed as high performers; 53 were deemed average performers and one carrier was deemed as a poor performer.

Based on the Performance Based Oversight (PBO) assessment, insurance carriers are placed into regulatory tiers: poor performers, average performers, and consistently high performers. The TDI-DWC will focus its regulatory oversight on the poor performers, as well as offer incentives within each tier that promote greater overall compliance and performance.

Insurance carriers were assessed on the timeliness of:

  • Medical bill processing,
  • Payment of the initial Temporary Income Benefits (TIBs) check,
  • Reporting medical billing data, and
  • Reporting the initial payment of TIBs to the TDI-DWC.

The TDI-DWC is required to monitor workers’ compensation system participants’ compliance with the Texas Workers’ Compensation Act and TDI-DWC rules and to correct noncompliant behavior. Compliance objectives are achieved through PBO, data monitoring, complaint handling, entity audits, and when appropriate, enforcement actions.

The results of this assessment and a listing of the assessed insurance carriers are posted on the TDI website at http://www.tdi.texas.gov/wc/pbo/pbo.html. Not all insurance carriers are assessed and placed into a regulatory tier.

Health care providers will be assessed separately in 2013.

Source: TDI-DWC

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