Workers Comp Carrier Performance Rankings Texas 2024
A tier-based Workers Comp Carrier Performance Rankings Report shows a common theme. Recently, the Texas Department of Insurance (TDI) released its biannual performance report on how carriers are performing. TDI assesses the performance of Workers Comp carriers every even-numbered year.
You can see the report here. I will not list the companies in each tier. The carriers also have a period of time to rebut the findings.
There are five Workers Comp carrier performance measures for the 2024 assessment. Check out the points assigned to each adjusting function in the graphic.
Insurance carriers will be placed into regulatory tiers based on the following measures. Notice that I bolded a common theme that I have written numerous articles over the years. I like it when agreement exists in the world of Workers Comp.
1. Timely payment of initial temporary income benefits by the insurance carrier.
2. Timely reporting of initial payment (IP) data to DWC via Texas Claim EDI Release
3.1.4. Note: This measure will not be factored into the tier placement. See Scoring
and Tier Placement on page 2.
3. Timely processing of initial medical bills by the insurance carrier.
4. Timely processing of requests for reconsideration of medical bills by the
insurance carrier.
5. Timely reporting of medical data to DWC via Texas Medical State Reporting
Release 1.0.
One can see that timeliness remains the key as it does in most of our claims reviews and with the TDI.
Generating Timeliness Increases Carrier Performance
Notice that 80% of the TPI workers comp carrier performance score comes from the initial payment of benefits and medical bills. How does a carrier or Third Party Administrator generate this timeliness? Requiring three point contact from the adjuster within 24 hours (not business hours) to the injured worker, medical provider, and employer almost always causes the file to start off well. Even if a First Report of Injury arrives at 3 PM on a Friday, waiting until Monday to investigate the claim can caused problems later in the file.
The 24 hour three point contact requirement causes these three things to happen:
- Claims investigation to determine compensability jump started
- Verification of the Circumstances of the accident with employer, employee, and medical provider
- Timely payment of initial benefits (indemnity and medical)
Bottom Line
The TDI workers comp carrier performance rankings show what results in good claims handling – timeliness.
