State News : Texas

NWCDN is a network of law firms dedicated to protecting employers in workers’ compensation claims.


NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.  


Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.


Contact information for NWCDN members is also located on the state specific links in the event you have additional questions or your company is seeking a workers’ compensation lawyer in your state.


Texas

STONE LOUGHLIN & SWANSON, LLP

  512-343-1385

Do We Love This Change?


The Division recently solicited comments on proposed changes to EDI Rules. According to our good friend Steve Nichols of Sentinel Governmental Affairs, the biggest issue is the short window of time provided for testing of the submission of claims EDI data.  In comments to the rule, Steve proposed additional time for testing so that insurance companies, EDI trading partners and the DWC could ensure successful claims data reporting. Steve cautioned the DWC and stakeholders to avoid a repeat of the NPI EDI data element change that resulted in enforcement actions, that could have been eliminated with adequate testing.  We await the DWC rule changes and hope that adequate consideration is given to these concerns.
 

No Love for this Fraudster


Earlier this month, DWC announced the arrest and indictment of a Houston area businessman who ran a $1.1 million insurance fraud scheme over a period of seven years. Kunal “Sonny” Puri had been charged with hiding employees and their payroll information under different companies in order to lower workers’ compensation insurance premiums payable to Texas Mutual, Service Lloyds and Travelers. If convicted, Puri faces up to 99 years in prison.  
 

 

What’s Trending in Comp Right Now?

 
The hot new injury in workers’ compensation seems to be a head injury.  Here at SLS we’ve noticed what appears to be an increase in claims with alleged head injuries.  

We don’t mean the kind like Massive Head Wound Harry from Saturday Night Live.  We’re talking about the ones where there is little or no evidence of a blow to the head such as a cut, bruise, or bump and diagnostic testing, such as CT scans or MRIs, is negative. These are often seen in slip and fall claims and other relatively minor incidents.  

These claimants may be diagnosed with a concussion (aka mild TBI) and post-concussion syndrome which consists of a broad range of symptoms that may include headaches, dizziness, fatigue, anxiety, and depression. These claims often don’t follow a normal healing pattern where the symptoms get better over time. Instead, they get worse.  

The problem with concussion and post-concussion syndrome is that the symptoms are difficult to independently verify.  The symptoms don’t show up on testing.  Instead, they’re based on what the patient tells the doctor and can be influenced by psychosocial factors and secondary gain issues.  In other words, a mild head injury is easy to fake.  For those that can’t figure out how, there are even detailed instructions available online:


 
One medical journal summarized the problem as follows:
 
These criteria are particularly difficult to confirm at the least severe end of the mild TBI continuum, especially when relying on subjective, retrospective accounts. The postconcussive syndrome is a controversial concept because of varying criteria, inconsistent symptom clusters and the evidence that similar symptom profiles occur with other disorders, and even in a proportion of healthy individuals.

Handbook of Clinical Neurology, Volume 127, 2015, Pages 131-156.

The apparent increase in claims with alleged head injuries may be due to more awareness of TBI by claimants generally as well as some doctors who are eager to diagnose concussion and post-concussion syndrome because they provide treatment for those conditions.  Regardless of the cause, the increase seems to be borne out by recent DWC data.  

DWC hosted a designated doctor stakeholder meeting on October 27, 2021. One of the issues identified was the lack of board-certified DDs to examine injured employees with TBI.  According to DWC, there are only 13 qualified doctors available for about 1,000 exams of traumatic brain injuries which includes concussion and post-concussion syndrome.

At one time, carpal tunnel syndrome was all the rage in workers’ compensation until scientific studies showed it is not caused by typing or most other workplace activities.  Hopefully, the same will happen with concussion and post-concussion syndrome and the frequency with which these conditions are alleged will drop as awareness of the science increases.

Carriers struggle to sort out legitimate claims from questionable ones because it is important to ensure that appropriate care is provided.  It doesn’t benefit the claimant to treat non-existent conditions and treatment is likely to be ineffective in the context of malingering.

Copyright 2021, Stone Loughlin & Swanson, LLP

Texas to Get Its Own Basic Manual


As we all know, Texas is special.  That may be the reason that the National Council on Compensation Insurance (NCCI) has proposed a Texas-specific edition of its Basic Manual for Workers Compensation and Employers Liability Insurance (Basic Manual).



Texas currently uses NCCI’s national Basic Manual with Texas exceptions. According to NCCI’s website, its Basic Manual contains rules, classification descriptions, and rates/loss costs for each classification, and state-specific exceptions for writing workers compensation insurance.

The new Texas edition does not make any substantive changes to any rule or classification that would result in premium impact.

TDI is taking comments on the proposed new Texas edition through January 14, 2022.    
For those interested in perusing the manual’s 2,054 pages, you can do so here.
 

Covid by the Numbers 


DWC just released its most recent statistics on Covid-19 claims.  The data is presented in DWC’s Covid-19 fact sheet titled COVID-19 in the Texas Workers’ Compensation System, December 2021.  The data runs through November 7, 2021.  

Insurance carriers reported a total of 61,331 Covid-19 claims to DWC, including 371 fatalities, from January 1, 2020 through November 7, 2021.  Almost half of the claims (45%) were from first responders and correctional officers.

Insurance carriers accepted 50% of Covid-19 claims with a positive test.  There were 16,673 Covid-19 claims with a positive test denied by carriers, presumably on the grounds that the infection was not shown to be work-related.  Of these denied claims, only 134 disputes were filed with DWC challenging the carrier’s denial.

Most of the benefits paid on Covid-19 claims were for indemnity benefits rather than medical benefits.  For claims with medical or indemnity benefits payments, 15% were paid with both, 20% had only medical benefits, and 64% had only indemnity benefits. These numbers suggest that many claims were not severe enough to incur medical benefits payments.

However, we’re not out of the woods yet.  Jeff Zients, White House COVID coordinator, said in a press briefing on December 17, 2021, “For the unvaccinated, you’re looking at a winter of severe illness and death for yourselves, your families, and the hospitals you may soon overwhelm.”

DWC continues to gather data on the impact of Covid-19 injuries on the Texas workers’ compensation system.  In this regard, DWC has extended its data call for certain information related to COVID-19 injuries reported to selected insurance carriers until June 30, 2022.

DWC’s current Covid-19 fact sheet can be viewed here.

Death on the Job*


DWC announced the release of its 2020 annual report on fatal work injuries on December 16, 2021. Here are some of the key takeaways. There were a total of 469 fatal work injuries in Texas in 2020 which is a decrease of 139 fatalities, or 23%, from 2019. The incident rate of fatalities in Texas was 3.9 per 100,000 full-time employees compared to 3.4 nationwide.  The construction industry had the highest number of fatalities with 127 incidents and the occupation with the highest number of fatalities was driver/sales workers and truck drivers with 101 incidents. Here is a breakdown of the 2020 fatalities by event or exposure:   



Also noteworthy, 93% of the total fatalities were men and 47% were Hispanic employees.
  
You can view the complete report here.  

*Death on the Job is a 1991 documentary film about work-related fatalities.  The AFL-CIO also publishes an annual report by the same name.
 

Let’s Talk About . . . Workers’ Comp


There are some big words in workers’ compensation.  To help everyone understand those words, DWC has created a glossary of terms with definitions in plain language. For example, one of our favorites:
 
Malinger – When an injured employee pretends to be sick or have an injury worse than it is to collect benefits longer than necessary.


Photo of injured employee malingering (DWC’s glossary does not include pictures but it may be something to consider for future editions).
    
Please let us know if you think of any alternate definitions for DWC’s workers’ compensation terms or any other terms that should be included.

Copyright 2021, Stone Loughlin & Swanson, LLP

The number of designated doctors in the workers’ compensation system continues to decline while the number of physicians in Texas hits record numbers.  

For the state’s fiscal year ended August 31, 2021, the Texas Medical Board issued a record 5,304 physician licenses. There are currently 94,544 physicians licensed in Texas.

However, all those doctors are not lining up to take the designated doctor certification exam. The number of designated doctors continues to shrink.  

In January 2020, there were a total of 384 designated doctors. By January 2021, the number had dropped to 318.  As of August 2021, we're down to a total of 272 designated doctors. Source.

Seventy-five of those designated doctors are physicians while the other 197 are chiropractors. In other words, over two and a half times more chiropractors are designated doctors than physicians.     

It appears that many physicians have made an economic decision that the costs of being a designated doctor are not worth the benefits while chiropractors are more incentivized by the current rates. If we want more and better designated doctors, we may need to pay them more. It’s likely to be less expensive than the costs associated with bad designated doctor reports.
 

Copyright 2021, Stone Loughlin & Swanson, LLP

On February 26 the Texas Supreme Court heard oral argument to determine whether the parents and sister of Fabian Escobedo, a truck driver who died from a rollover accident on the job, may sue the Employer. The Employer argued that recovery of benefits under the Texas Workers’ Compensation Act is the exclusive remedy for Mr. Escobedo and that the parents and sister could not bring a wrongful death action under the gross negligence exception in the Act because that exception authorizes actions only by a surviving spouse or heirs of the body of the deceased. The parents and sister pointed out that the supreme court has previously held that the Act does not bar a deceased’s cause of action forintentional injuries which survive to the estate under the Texas Survival Statute. Accordingly, at issue is whether Mr. Escobedo suffered personal injury prior to deathdue to the Employer’s intentional acts or omissions.

To support their claim, the parents and sister pointed to evidence in the record that (1) oil fields in West Texas and South Texas were booming and the Employer could not keep up with the demand for drivers, (2) drivers were required to work unsafe amounts of overtime, (3) the Employer required drivers to work illegal amounts of time, (4) the Employer required drivers to falsify their driver logs to cover up the illegal hours, and (5) a terminal manager warned a supervisor that a driver would be killed because of the unreasonable driving hours and the supervisor said “we will cross that bridge when we come to it.” 

The supreme court has previously held that the intentional failure to furnish a safe workplace does not rise to the level of intentional injury, except when the employer believes his conduct issubstantially certain to cause injury. Thus, in the present case, the task for the supreme court is to decide whether the evidence could support a finding that the trucking company believed its conduct was substantially certain to cause injury to Mr. Escobedo. If so, the parents and sister will be allowed to sue. 

The Corpus Christi court of appeals concluded that the evidence in this case could support such a finding. The supreme court’s decision is expected later this year.  MO-VAC Service Co. v. Primitivo Escobedo, et al
 

-  Copyright 2020, David Swanson, Stone Loughlin & Swanson, LLP

The Division of Workers’ Compensation has initiated a review of the “utility and sufficiency” of the standard form interrogatories for contested case hearings. The form interrogatories are sets of questions, prescribed by DWC, that parties may serve in discovery prior to a CCH. There are two sets of form interrogatories, which are Claimant’s Interrogatories to Carrier andCarrier’s Interrogatories to Claimant. They each contain 11 standard questions prescribed by DWC and allow the party to draft 5 additional questions.

The current interrogatories were adopted in 1991 and they are now widely viewed as inadequate. The DWC is requesting comments and suggestions from stakeholders regarding revisions, and it will hold a stakeholder meeting to discuss possible changes on March 31, 2020 at the DWC Metro building in Austin. 
 

-  Copyright 2020, David Swanson, Stone Loughlin & Swanson, LLP