Informal Draft of Pharmacy Closed Formulary Rules Posted by Texas Department of Insurance

The Division drafted its latest version of the proposed Closed Pharmacy Formulary Rules and asked for informal comments by March 5, 2010. The Division has been working on the closed formulary for several years. Significant issues regarding Division resources to address any expected disputes with legacy...

Texas Performance Based Oversight Work Group Meeting Study

The Division conducted its second Performance Based Oversight (PBO) work group meeting. Stakeholders discussed various measures to assess the performance of insurance carriers. Although options were discussed, the Division may keep the same four measures from the previous study. Those measures are as...

Texas Medical Economic Index Increases

Healthcare providers have alerted the Division of Workers' Compensation that several venders have not incorporated the recent MEI increases for medical bill reimbursement. According to the new fee schedule, the MEI may increase annually. Apparently, some vendors have not updated their software. ...

TX: Wrongful Death Lawsuit Filed Over Gulf Oil Rig Explosion, Fire

HOUSTON , TX - Attorneys with the Houston trial law firm Arnold & Itkin LLP yesterday filed a wrongful death lawsuit on behalf of the family of Aaron Dale Burkeen , one of 11 men still missing after the recent oil rig explosion in the Gulf of Mexico . A resident of Philadelphia, Miss. , Mr. Burkeen...

TX: Harris County Jury Awards $1.55M to Worker Injured at Maritime Terminal

HOUSTON, TX - An international container terminal operating company that offered to pay only $35,000 to a worker seriously injured by an employee driving a yard truck must pay the injured man $1.55 million, a Texas jury has ruled. The injured man, Gilberto Villegas, was represented in the Harris County...

Texas: Maximum Medical Improvement/Impairment Rating Appeals Decision No. 100152

The Designated Doctor evaluated the injured worker and determined she was not at maximum medical improvement because she was considering surgery. The Claimant did not have surgery. Subsequently, DWC sent a letter of clarification to the Designated Doctor indicating the Claimant reached statutory maximum...

TX: DWC Changes Conversion Factors For WC Medical Fee Guidelines

Dallas, TX (CompNewsNetwork) - The purpose of this bulletin is to inform system participants of the annual change to the Medical Fee Guideline conversion factors as established in 28 Texas Administrative Code (TAC) §134.203. As directed by Texas Labor Code §413.011(a), fee guidelines adopted...

Texas: Performance Based Oversight Committee Update

By Stuart D. Colburn, Esq., Shareholder, Downs Stanford The Division of Workers’ Compensation (DWC) is holding stakeholder meetings regarding Performance Based Oversight (PBO). The Division is seeking stakeholder input to add additional measures. Currently, the Division measures carriers on...

Texas: Performance Based Oversight Committee Update

By Stuart D. Colburn, Esq., Shareholder, Downs Stanford The Division of Workers’ Compensation (DWC) is holding stakeholder meetings regarding Performance Based Oversight (PBO). The Division is seeking stakeholder input to add additional measures. Currently, the Division measures carriers on four...

Texas: SORM v Rodriguez 08-10-00278

By Stuart D. Colburn, Esq., Shareholder, Downs Stanford This case addresses when a DWC-69 is required after a change in an impairment rating (IR) due to a mathematical error. State Office of Risk Mgmt. v. Rodriguez , 2011 Tex. App. LEXIS 6839 (Tex. App. El Paso Aug. 26, 2011) . The Appeals Panel...

Texas: SORM v Rodriguez 08-10-00278

By Stuart D. Colburn, Esq., Shareholder, Downs Stanford This case addresses when a DWC-69 is required after a change in an impairment rating (IR) due to a mathematical error. State Office of Risk Mgmt. v. Rodriguez , 2011 Tex. App. LEXIS 6839 (Tex. App. El Paso Aug. 26, 2011) . The Appeals Panel...

Texas Case Management

By Stuart D. Colburn, Esq., Shareholder, Downs Stanford The preamble to New Rule 137.5 is causing a controversy and perhaps a significant increase in costs to employers and carriers. Tex. Lab. Code Sec. 413.021(a) , states: "The insurance carrier shall evaluate a compensable injury in which...

Texas Case Management

By Stuart D. Colburn, Esq., Shareholder, Downs Stanford The preamble to New Rule 137.5 is causing a controversy and perhaps a significant increase in costs to employers and carriers. Tex. Lab. Code Sec. 413.021(a) , states: "The insurance carrier shall evaluate a compensable injury in which...

Texas: City of Port Arthur v. Brown

This case [ 2011 Tex. App. LEXIS 7881 ] concerns when a jury can disregard the testimony of the only expert who provided opinions or testimony to a jury. Tanner Brown was a City of Port Arthur (City) employee injured during a low-impact collision while riding in a city-owned vehicle. The injured worker...

Texas Performance Based Oversight (11/2/2011)

The Division is evaluating the current criteria Performance Based Oversight (PBO) committee meetings and seeking additional measures. The Division is also accepting input on the weights given to the various measures, a re-assessment opportunity, procedure to challenge or provide additional evidence regarding...

Texas: TPCIGNA v Brooks 03-10-00428

By Stuart D. Colburn, Esq., Shareholder, Downs Stanford This case concerns application of the TX Supreme Court's decision in Leordeanu v. American Protection Ins. Co., 330 S.W.3d 239 (Tex 2010) . The claimant in Tex. Prop. & Cas. Ins. Guar. Ass'n v. Brooks, 2011 Tex. App. LEXIS...

Texas: Performance Based Oversight (12/23/11 Update)

Beginning January 1, 2012, the Division of Workers’ Compensation (DWC) will begin its six month collection of data to assess insurance carriers for Performance Based Oversight (PBO). The PBO period will last until June 30, 2011. The PBO measures are as follows: Timely Initial Payment of Benefits...

Texas: Potential Enforcement Action

The Division is reminding system participants that enforcement actions may be taken against stakeholders who perform any activity in violation of the statutes or rules. Recent reminders include: A. New EDI Forms The Division created new EDI forms including the EDI-01, EDI-02, and EDI-03. Carriers...

The Texas Supreme Court Grants Rehearing in Ruttiger

By Nicholas Canaday, III, Shareholder, Downs Stanford, P.C. Re: Texas Mutual Insurance Co. v. Ruttiger , 265 S.W.3d 651 (Tex.App.-Houston [1 st Dist.] Jul 31, 2008) (NO. 01-06-00897-CV), review granted (Mar 12, 2010); Judgment Reversed, in part; Rehearing Granted (Feb. 17, 2012). Synopsis: ...

Walmart Opts Out

The Texas Tribune reports on Walmart's heavy blow to the Texas workers' compensation system when the retail giant decided to opt out in March 2012. Texas is currently the only state where employers can opt out of the workers' compensation system. Benefits for injured workers under private...

Opting Out is the New “In” Thing: Study Discusses Alternatives to Workers’ Compensation

By John Stahl, Esq. The astronomical benefits-related costs, protracted dispute resolution process, and numerous other ills associated with workers’ compensation that have prompted reforms have also increased support for the “opt-out” movement. Opting out initially requires that...

Opting Out is the New “In” Thing: Study Discusses Alternatives to Workers’ Compensation

By John Stahl, Esq. The astronomical benefits-related costs, protracted dispute resolution process, and numerous other ills associated with workers’ compensation that have prompted reforms have also increased support for the “opt-out” movement. Opting out initially requires that a...

I Walked Out Into West, Texas

By Stephen C. Embry, Esq. On April 17, 2013 an explosion at the West Chemical and Fertilizer Co., registering 2.1 on the Richter scale, leveled the plant and much of the surrounding town of West, Texas. The explosion was so powerful and destructive that it created a cloud of confusion as well as a...

CWCI Study Examines Potential Impact of a Drug Formulary in California Workers’ Comp

A new California Workers’ Compensation Institute study shows that adopting a state-mandated workers’ comp prescription drug formulary such as those used in Texas and Washington State could reduce California workers’ compensation pharmacy payments by an estimated $124 million to $420...

Ohio: Statute Precluding Comp Coverage for Worker Temporarily in the State Does Not Apply to Employee of Texas Non-Subscriber

Like a number of other states, Ohio has a provision in its comp act [ORC Ann. § 4123.54(H)] precluding workers’ compensation coverage for an employee when: (1) the employee is a resident of another state; (2) the employee is insured in a state other than Ohio; and (3) the employee is only...