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:

• • • 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.

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:

• • • Set performance expectations
    • Reward excellence
    • Encourage continuous improvement.

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: 

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.