DWC Extends and Enlarges COVID-19 Data Call
Last spring the Texas Department of Insurance, Division of Workers’ Compensation, issued a mandatory data call for certain information related to COVID-19 injuries reported to selected insurance carriers on or after December 1, 2019. The action, which was announced in Commissioner’s Bulletin No. B-0029-20 followed the agency’s request for public comment from system stakeholders to help shape the parameters of the data call. The data was initially requested in three phases.
The Division has now enlarged the data call to include an additional intergovernmental risk pool and several self-insured independent school districts. Moreover, in Commissioner’s Bulletin No. B-0003-21, DWC extended the data call through June 2021for all selected carriers by adding two additional phased responses.
Upcoming COVID-19 Data Call Submission Deadlines
Submissions for the first and second data calls were completed August 17, 2020 and October 30, 2020. The third submission is due January 29, 2021. The data call extension now includes two more submissions: April 30, 2021 and July 30, 2021.
| The Division has directed all selected insurance carriers and insurance carrier groups to provide summary data using the COVID-19 data call reporting forms and instructions. Each selected insurance carrier or group is required to provide one data submission per insurance carrier or group. | Deadline For Submission to DWC |
| COVID-19 exposures and injuries reported to the insurance carrier from December 1, 2019, through December 31, 2020, and payments made on those injuries as of December 31, 2020. | January 29, 2021 |
| COVID-19 exposures and injuries reported to the insurance carrier from December 1, 2019, through March 31, 2021, and payments made on those injuries as of March 31, 2021. | April 30, 2021 |
| COVID-19 exposures and injuries reported to the insurance carrier from December 1, 2019, through June 30, 2021, and payments made on those injuries as of June 30, 2021. | July 30, 2021 |
Insurance carriers and groups must submit the requested data to DWC through the insurance carrier Austin representative’s Secure File Transfer Protocol box no later than 5 p.m., Central time on the date the call is due. If FO&L serves as your Austin Representative, please coordinate your planned data submission with our office through Heather Terrones at hta@fol.com.
Data call submissions are cumulative. They should include all COVID-19 exposures and injuries reported and payments made on these injuries from December 1, 2019, through each applicable date.
Only selected insurance carriers/groups are required to comply with the data call. Selected insurance carriers must provide summary data using the COVID-19 data call reporting forms and instructions. Each selected insurance carrier or group is required to provide one data submission per insurance carrier or group. However, all insurance carriers should maintain injury level data for the injuries reported in this data call and may be asked to submit that data to DWC in the future.
The Report and Key Findings
The Division has periodically released the results of earlier data call submissions though the Research and Evaluation Group. In its most recent report, COVID-19 in the Texas Workers’ Compensation System, the REG highlighted the following key findings from the research:
Claim frequency: The sharp increase in COVID-19 occupational disease claims reported so far in 2020 has temporarily interrupted a 20- year trend in Texas of 
fewer workers’ compensation claims reported each year. Since new reportable claims are still being reported, these statistics may change over time. Total number of claims reported to DWC from January to August 2020 was about 22% higher than the same period in 2019.
COVID-19 claims: As of September 27, 2020, insurance carriers reported more than 25,000 COVID-19 claims and 100 fatalities to DWC. Most of these claims and fatalities involve first responders and correctional officers/prison workers.
Claims with positive tests or diagnoses: 35% of all claims involved injured employees who tested positive or were diagnosed with COVID-19.
Denials and disputes: Insurance carriers accepted almost half (48%) of COVID-19 positive test claims. Despite more than 1,633 denials of COVID-19 claims with positive tests or diagnoses, there were only five requests for benefit dispute resolution filed with DWC as of September 27, 2020.
Benefits paid: For COVID-19 claims, most of the benefits paid were indemnity benefits (particularly employer salary continuation), compared to medical benefits.
Background and Conclusions
On March 13, 2020, Texas Governor Greg Abbott issued a statewide disaster declaration for COVID-19. While state and local efforts are being made to address the pandemic, there are many unknowns about its ultimate impact on the Texas population and economy, and on employees and employers covered under the state’s workers’ compensation system.
Early in the pandemic, DWC monitored the COVID-19 claims reported by insurance carriers and realized that many of these claims appeared to be 
“exposure-only” claims, with no documentation of whether the injured employee tested positive for COVID-19. Many of these claims were being investigated and either accepted or denied by the insurance carrier, based on whether the injured employee could provide medical evidence of a positive test or diagnosis, as well as documentation showing a connection between the COVID-19 infection and work. In an effort to understand the proportion of these COVID-19 claims with a positive test or diagnosis, DWC issued a data call with 66 insurance carriers representing the State of Texas, political subdivisions, commercial insurance carriers, and certified self-insured employers.
The Division published a list of 66 carriers who are participants in the data call. These carriers include four state workers’ compensation systems, 17 Texas cities who self-insure, 12 self-insured Texas counties, 6 Texas hospital districts who self-insure, 6 intergovernmental risk pools, 2 certified self-insured employers, and 19 commercial insurance carriers or carrier groups.
Researchers discovered that 61 percent of the state’s COVID-19 cases were concentrated in 10 counties. Those counties are Harris, Dallas, Tarrant, Bexar, Hidalgo, Travis, El Paso, Cameron, Fort Bend, and Nueces. Similarly, about 57% of the state’s COVID-19 workers’ compensation claims were concentrated in these same 10 counties.
Overall, the results of the data call (for claims reported to the insurers as of June 30, 2020), showed that 35% of the COVID-19 claims involved an injured employee who tested positive or was diagnosed with COVID-19 (Figure 6). Among these positive test claims, nearly half (48%) were accepted as work-related by insurance carriers, more than a third (38%) were denied by the insurance carriers, and 14% were still under investigation. These statistics vary across types of insurance carriers. COVID-19 claims being processed by the State of Texas reported the highest rate of denials (72%); however, commercial insurance carriers had the highest number of denials.
Reminder on COVID-19 Coding
In the past, Division staff has voiced concerns that they had not been seeing the reporting of as many COVID-19 claims as had been anticipated. Under Rule 120.2 (a) an employer must notify its carrier of each death or occupational disease it receives notice of, as well as any injury that results in more than one day’s absence from work. The employer must do so within eight days of receipt of this notice. Carriers must then electronically file specific information from the original Employer’s First Report of Injury not later than the seventh day after receipt of such a required report where there is lost time from work or an occupational disease. Rule 124.2(c) (1) (A).
It is also important to remember that DWC issued the following coding guidance in a memo March 27, 2020. DWC expects carriers to use the International Association of Industrial Accident Boards and Commissions codes for EDI claims reports: “cause of injury” code 83 -Pandemic and “nature of injury” code 83 – COVID-19 on April, 2020. We recommend that you remind those persons within your organization who are responsible for injury coding of this obligation. If the coding has been omitted on claims reported on or after April 1, 2020, we recommend going back and amending your reporting to include the proper coding.
If you have any questions regarding this data call, please contact Bobby Stokes or James Sheffield.
FOLIO
