Texas Workers Compensation System Changes

Several significant changes have taken place with the Texas Workers’ Compensation
Commission. TWCC as we know it will now become either the Workers Compensation Division
or the Division of Workers Compensation as a result of HB 7.  This change is a result of having
the entity of TWCC placed under the jurisdiction of Texas Department of Insurance (TDI).  The
change is effective September 1, 2005.  Governor Perry signed this bill June 1, 2005 in an effort to
improve the status of our current system.  It is intended that restructuring some of the key
components of the process will remedy issues such as high costs and delayed times in  which
patients return to work.  Though hospitals and physicians will both be affected by the changes,
many of the common processes used will remain the same such as Benefit Review Conferences
and Contested Case Hearings.  

Key changes:

• The Ombudsman Program will now be transferred to the Office of Injured Employee
  Counsel (OIEC)
  
• After Medical Dispute Resolution, a party will not be able to file with the State Office of
  Administrative Hearings
  
• TDI will regulate WC networks
  
• 6 Commissioners (3 labor representatives and 3 employer representatives) will now be
  replaced by a 1 Commissioner of Workers Compensation
  
• The Medical Advisory Committee (MAC) is dissolved
  
• The position of Medical Director is dissolved
  
• Claims Adjustors may not be Case Managers
  
• All physical and occupational therapy will require prior authorization
  
• Claims will now have to be submitted within 95 days from discharge
  
• If carrier requests an audit, 85% of fee guideline or contracted rate should be paid within
  45 days of receiving the claim
  
• As soon as carriers begin receiving electronic claims, process will be initiated to
  electronically pay claims to providers
  
• Out-of network injured worker may have a doctor of choice at an RME
  
• An in-network injured worker must have their treating  physician attend RME
  
• Designated Doctors will now have to report on the extent of the injury, whether or not it
  appears compensable, and timing for patient to return to work
  

For more information, please contact Angie Box at (817) 200-2820, ext. 206