WC Commissioner Brannan says Enforcement, Rulemaking, Lead DWC Initiatives
Texas Workers’ Compensation Commissioner Ryan Brannan addressed a packed house at the Insurance Council of Texas’ Workers’ Compensation Annual Conference being held in Austin this morning. The Commissioner took the opportunity to lay out the agency’s key goals and initiatives for the coming year. With Commissioner of Insurance David Mattax in the audience, Commissioner Brannan identified several rulemaking initiatives that the Division is currently pursuing or looking to pursue.
Commissioner Brannan said that the Division is considering multiple stakeholder requests to engage in rulemaking to develop fee schedules for ground ambulance and air ambulance fees. Moreover, the Commissioner said that the Division is planning to post a working draft of proposed rules to address criteria to qualify as a designated doctor in the system. The Commissioner anticipates that this working draft will be posted in the fall. In addition, the Commissioner stated that he expects to engage in rulemaking that will involve a reorganization of the medical fee guidelines. While this anticipated change is expected to be non-substantive, the Commissioner said that one goal will be to make it easier to open up rulemaking in the future for targeted changes. The Division is also reevaluating its document-retention program, which presently requires storage of claim file materials for 50 years.
On the enforcement front, Commissioner Brannan told attendees that one focus of the agency will be to assure that parties are delivering required medical records to designated doctors in accordance with Division rules. Currently, Rule 127.10 requires the treating doctor and the insurance carrier to provide the designated doctor with copies of all the employee’s medical records in their possession relating to the medical condition to be evaluated by the designated doctor. Those records, and any written analysis on the claim must be received by the designated doctor no later than three working days prior to the date of the designated doctor examination. Designated doctors are required to report a violation of this requirement to the Division within one working day of not timely receiving the records.
The agency will continue to audit the accuracy of LIBs and DBs payments, with a special focus on the carrier’s efforts to secure an accurate and timely wage statement, as well as the carrier’s calculation of the correct benefit amount. Carriers have been told for more than a year at this point that they must redouble efforts to secure wage statements that include non-pecuniary wage information, as well as the employer’s willingness to continue non-pecuniary wages to the employee during the period of disability. This will be a heightened area of enforcement in the coming year. The Commissioner also made a point to advise carriers of their obligation to comply with agency orders (including designated doctor opinions) after they have been issued.
The Division is still monitoring the effectiveness of its pilot program to resolve MMI, IR and extent-of-injury disputes, which has been ongoing in the Weslaco Field Office for the past six months. If the program is determined to be effective, the Commissioner said that it would be expanded to other field offices in the state. Commissioner Brannan added that the agency has no current plans to mandate the program in any field offices, however. It is strictly a voluntary initiative.
Commissioner Brannan emphasized that the agency expects parties and their representatives to attend dispute resolution proceedings with full authority to effectuate resolution of disputes. He said that the Division is looking for ways to encourage adherence with this obligation.
For some time, the Division has assisted the Office of Injured Employee Counsel in finding ways to obtain resource witnesses on issues involving medical causation. This is still a goal of the agency, according to Commissioner Brannan. Several sources for such witnesses have been identified and the Division will continue to encourage assistance to injured workers in this regard.
Finally, the Commissioner stated that the carrier quarterly meetings, which foster a dialogue between agency staff and carrier stakeholders will continue. The agency is also implementing a series of health care provider meetings on a quarterly basis.
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