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

  Our Website

  512-343-1300

  512-343-1385


Penalty of the month

 
The largest fine levied against an insurance carrier in May was for $9,000.00 in Consent Order 2024-8648 dated May 7, 2024.  Violations included failure to timely pay TIBs, failure to timely act on a medical bill, failure to timely pay a designated doctor, and failure to respond to an injured employee’s request for reimbursement.  

The facts that caught our attention were for failing to respond to an injured employee’s request for reimbursement.  The order states that the injured employee obtained a travel reimbursement form from the carrier’s third-party administrator (TPA) website.  However, this form did not contain any language explaining the proper method for submitting travel reimbursement requests under DWC rules.  

When the employee submitted the request on this form, the carrier failed to respond and failed to direct the employee to use form DWC048, Request to Get Reimbursed for Travel Expenses.  In its defense, the carrier “cited the injured employee’s use of its own form as justification for the late payment.”  In other words, the carrier argued that it did not timely respond because the employee used the wrong form (which they gave the employee).  

This argument clearly did not go over well with DWC given that DWC chose to include it as a finding of fact in the consent order.  This order serves as a good reminder that carriers are responsible for the acts of their agents and need to keep a close eye on them.
 


DWC offers educational resources to help avoid penalties


Texas has a very robust enforcement system as demonstrated by the numerous disciplinary orders issued each month. While some system participants may view administrative penalties as part of the “cost of doing business” in this state, for those that don’t like to pay fines, DWC now offers its CompCourses live webinar series where system participants can learn more about the Texas workers’ compensation system.
 
The most recent CompCourses live webinar was presented on May 22, 2024 and covered presiding officer directives (PODs). The recording is now available on DWC’s website and can also be viewed here. As an added bonus, attendees also receive continuing education credit for attending a live CompCourses webinar so stay tuned for upcoming webinars.

DWC closes medical billing complaint loophole


On May 7, 2024, DWC adopted amendments to rule 180.2 concerning filing a complaint.  The amendments prevent health care providers from using the complaint process to circumvent the one-year filing deadline for medical fee disputes. The amended rule states:    
A health care provider cannot submit a complaint about a medical billing issue if the date of service for the medical billing issue was more than 12 months before the date of the complaint, unless the issue qualifies for an exception to the filing deadline under §133.307(c)(1)(B) of this title, concerning medical fee dispute resolution. If the issue qualifies for an exception to the medical fee dispute resolution filing deadline under §133.307(c)(1)(B), then a health care provider cannot submit a complaint about that issue if the medical fee dispute resolution filing deadline in §133.307(c)(1)(B) has passed. 
The rule also notes, “This subsection does not apply to a health care provider submitting a complaint under Insurance Code Chapter 1305.”  Section 1305.401 of the Workers’ Compensation Health Care Network Act requires each network to implement and maintain a complaint system to resolve complaints.  A health care provider may submit a complaint to the network over a fee dispute and if dissatisfied with the outcome, the provider may file a complaint with TDI’s complaint resolution process.

In-network fee disputes are not governed by Section 413.031 of the Workers’ Compensation Act and so there is not a one-year filing deadline for those disputes. DWC also does not have jurisdiction to resolve disputes over fees for medical services provided subject to a network contract.  Those are contract disputes that are governed by the terms of the contract between the network and health care provider and if the dispute is not resolved through the complaint process, it can be resolved through litigation or arbitration, if the contract mandates arbitration.

Mental health post-pandemic


Our friends at IMO just published a new article that discusses many of the current stressors we are all facing that have led to an increase in mental health issues and it offers helpful strategies to maintain good mental health.  It’s well worth a read: Mental Health — Managing the Growing Chaos Among Us.

Copyright 2024, Stone Loughlin & Swanson, LLP


Movin’ on up!


Amanda Barlow, Administrative Law Judge in the Fort Worth Field Office since 2015, is joining the Division Appeals Panel.  Judge Barlow is the current Secretary of the Texas State Bar workers’ compensation section.    Judge Barlow obtained her law degree in 2007 from Texas Wesleyan University which was acquired by Texas A&M in 2013 and is now known as the Texas A&M University School of Law.  In 2024, it was named the 26th best law school in the country by U.S. News & World Report. Gig Em, Aggies!  We look forward to her bringing her nine years of practical experience to the jurisprudence of the Appeals Panel.    

Copyright 2024, Stone Loughlin & Swanson, LLP

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