Late Medical Bills Won’t Be a Reason for Workers’ Comp Claims Denials, State Says
By Joey Berlin

IPPS_Rule

The Texas Division of Workers’ Compensation (DWC) says late filings of medical bills will fall under the law’s “catastrophic event” exception due to the COVID-19 pandemic. 

DWC made the announcement among several policy notes in a bulletin it released Wednesday. The division said the bulletin would be in effect either for the duration of Gov. Greg Abbott’s declaration of a statewide public health disaster or until further notice. 

“Failure to submit a timely medical bill will be deemed an exception due to a catastrophic event under Labor Code Section 408.0272(b)(2),” the bulletin said. That law says a health care practitioner’s claim won’t get denied solely for a late filing if “the commissioner determines that the failure resulted from a catastrophic event that substantially interfered with the normal business operations of the provider.” 

DWC also says in the bulletin that it “will take into account the challenges system participants are facing when considering enforcement actions.” 

Also among the agency’s notes in the bulletin: 

  • DWC is ceasing orders for and suspending designated doctor exams, required medical exams, and referral exams that have already been ordered. 
  • Workers’ compensation insurance carriers must “continue or begin” providing timely claims adjustments; timely processing and delivery of indemnity benefits and medical payments; and “authorizing payments to pharmacies up to a 90-day supply for any prescription medication, subject to the remaining number of days authorized by the prescribing provider, regardless of the date the prescription was most recently filled.” 

Earlier this week, the division published a reminder that “an employee must have been injured or contracted an occupational disease (such as COVID-19) as a result of their employment” to file a successful claim for workers’ compensation due to a COVID-19 infection. “Whether a workers’ compensation claim is compensable or not is a case by case determination by the insurance carrier.” 

You can also find the latest news, resources, and government guidance on the coronavirus outbreak by visiting TMA’s COVID-19 Resource Center regularly.

 

Last Updated On

March 26, 2020

Originally Published On

March 26, 2020

Related Content

Coronavirus | Workers Compensation

Joey Berlin

Associate Editor

(512) 370-1393
JoeyBerlinSQ

Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

More stories by Joey Berlin