DWC Releases 2024 Insurance Carrier PBO Results
DWC has released the 2024 insurance carrier performance based oversight results. Insurance carriers were assessed on their performance in five measures:
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- Timely payment of initial temporary income benefits.
- Timely reporting of initial payment data to DWC by electronic data interchange (EDI).
- Timely processing of initial medical bills.
- Timely processing of requests for reconsideration of medical bills.
- Timely reporting of medical data to DWC by EDI.
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DWC regularly evaluates insurance carriers and health care providers for compliance with Texas Labor Code Section 402.075 and 28 Texas Administrative Code (TAC) Section 180.19. Performance Based Oversight (PBO) is a review of Insurance Carriers’ and health care providers’ performance in selected areas of compliance. According to DWC, the purpose of PBO is to:
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- Set performance expectations
- Reward excellence
- Encourage continuous improvement.
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Information about DWC’s assessment methodology, selection criteria, data time frame, data sources, rebuttal procedure, scoring, and the impact of tier ratings can all be found at https://www.tdi.texas.gov/wc/pbo/documents/pbo2024icplan.pdf.
Here are the Insurance Carrier Tier Assessments Overall Results:
| Assessment Year | Insurance Carriers | High Tier Performers | Average Tier Performers | Poor Tier Performers |
| 2024 | 130 | 44 | 82 | 4 |
The Insurance Carrier PBO tier placement list can be found at https://www.tdi.texas.gov/wc/pbo/documents/pbo2024tieric.pdf.
Should you have any questions about PBO generally, or about your tier placement, please reach out to FOL Managing Shareholder James Sheffield at jrs@fol.com or (512) 435-2169.
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