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No ‘pixie dust’ for reform, Texas work comp chief says

With that statement Texas Commissioner of Workers’ Compensation Albert Betts introduced his message to a crowd of insurance professionals attending the annual conference of the Southwestern Insurance Infor-mation Service, held in Dallas in June. Updating the audience on the status of the Texas workers’ compensation system reforms that began last year, Betts said the undertaking is a massive one.

“We started off in September of last year, and even today I think there’s a perception out there that there’s a switch that got flipped on that made it [all okay]. … There is no magic fairy. There is no pixie dust. … This is a major overhaul of the workers’ compensation in this state,” Betts said.

Reform started with the establishment of a new form of governance. The former workers’ compensation commission was abolished and Texas Department of Insurance Division of Workers’ Compensation was established, along with the Office of Injured Employee Counsel (OIEC).

Betts explained that three officials within TDI, all appointed by Gov. Rick Perry, have a stake in governing the system—Insurance Commissioner Mike Geeslin, Betts, and Public Counsel Norman Darwin, who heads the OIEC and represents the interests of injured workers. “We are appointed, none of us report to the other,” Betts said. “It was told to us—either we all hang together or we all hang separately.”

Betts described the focus of re-form so far: health care networks; re-turn to work; medical treatment guidelines; the medical dispute process; and an overall management plan.

TDI and Commissioner Gees-lin are responsible for regulating the networks, he said. “There’s been some grumbling that we’ve been taking too long to approve networks, but the key here is for us to make sure these networks are adequate, they are appropriate. These networks are not set up for medicine on the cheap,” Betts said. “… The department has been very careful in approving and reviewing those networks.”

He noted that getting injured employees back to work is a priority, which was not always the case in the past. Under the old system, he said, the emphasis was on income benefits and treatments, but “we neglected to talk about … when are you going to be able to go back to work?” He said his staff has been trained on “how to have that conversation … we are trying to make sure… that we talk about return to work as an outcome. This is very important,” in controlling system costs.

Betts said medical treatment guidelines will be a boon to both providers and insurers alike. The guidelines will give “the treating physician some sense of what are my parameters given what the general nature of this injury may be, but [they] also help the carriers better manage care,” Betts said. With the guidelines, both parties will know what is considered reasonable care for particular injuries.

The commissioner said he was surprised to find out after he took the job that there were some 14,000 medical disputes pending. “It was cheerily reported to me it was down from about 40,000 at some point.” He said changes to the medical dispute process include applying “some legal principles”—getting carriers and providers together to talk to each other to iron out differences. “Commissioner Geeslin and I, in a combined letter, basically told the world you either need to settle these disputes or we’re going to start issuing decisions,” Betts said. Disputed amounts “range anywhere from $50 to up to … a potential award of $100,000. So these are fairly significant,” he said.

“At the end of the day, forget the provider, forget the employer, forget the carrier, it’s about that injured worker,” he concluded.