Insurance providers are responsible for responding to workers compensation claims properly, and medical providers are responsible for completing and filing the appropriate paperwork as it applies to their patients. The fact that there have been recent workers’ compensation enforcement actions in Texas indicates that some workers have experienced difficulties in claiming the workers’ compensation benefits due to them. However, those who have difficulties do have recourse. Fortunately, the Division of Workers’ Compensation at the Texas Department of Insurance, or TDI–DWC, provides oversight for workers’ compensation. If a Texan is injured at his place of business, he can expect a reasonable response from his insurer and medical provider or an irresponsible party could be held accountable through enforcement actions.
Workers’ Compensation Compliance
For workers in the state of Texas, workers’ compensation is governed by the Texas Labor Code as well as rules set forth by the Commissioner of Workers’ Compensation. Insurers and medical providers are required to respond adequately to an injured person’s claim, or they could become subject to workers’ compensation enforcement actions.
Recent Failures and Enforcement Actions
Insurers or medical providers who fail to take the appropriate actions for workers can be subject to penalties such as mandatory participation in a compliance plan developed by a TDI–DWC medical provider, payment of a fine, or restriction from the Designated Doctor’s List. Recent fines have ranged from a few hundred dollars to tens of thousands of dollars.
Recent enforcement actions indicate that the failure of insurers to pay medical bills in a timely manner, the failure to pay income benefits in a timely manner, and attempts to decline payment for preauthorized medical services are not acceptable and will not go unnoticed. Medical professionals are also being held to certain standards, including the completion of TDI-DWC paperwork, proper determination of impairment and other duties related to providing sufficient care for workers.