House Bill 7, passed in 2005, offered Texas the tools we needed to make drastic improvements to the workers’ compensation system. Transferring regulation of the program to the Texas Department of Insurance and creating a Department of Worker’s Compensation (DWC) has had a positive impact.
Even though the fee schedule was improved, many physicians don’t participate in the program. Only 30 percent of Texas physicians indicate they accept new injured workers covered by workers’ compensation. Physicians simply cannot afford the additional burden and hassle created by the workers’ compensation insurance industry.
Strategies health insurers use to deny paying injured workers’ medical claims include inappropriate use of treatment guidelines, last-minute scheduling of peer reviews, tedious preauthorization requirements, and arduous prospective and retrospective review to determine if physician payment is warranted.
As DWC goes through the sunset process, TMA trusts legislators to remove these obstacles so physicians can better care for injured workers. Health insurers’ unnecessary interference only serves to keep physicians out of the system. Healthy workers are vital to the Texas economy and injured workers deserve better.
Medicine’s 2011 Agenda
- Support measures that improve communication between employers and physicians so the injured worker can return to work in a timely fashion.
- Reduce administrative hassles by simplifying preauthorization and avoiding last-minute scheduling of peer reviews.
- Support legislation that ensures non-network physicians receive appropriate payment for services provided to injured workers.
- Texas employers pay high workers’ compensation premiums relative to other states. They expect their employees’ work-related injuries to be treated appropriately and efficiently.
- Injured workers should be able to obtain clinically appropriate, cost-effective health care in a timely manner and without having to travel unreasonably far. Any system providing health care to injured workers should be clearly defined, fair, simple to understand, accountable, and easily accessible by all parties involved.