The 77th Legislature has passed reforms to the Texas Workers’ Compensation
System. The bill contains 17 articles and is a comprehensive piece of legislation
that will impact many portions of the current law.
1.
Research has shown that medical
cost and utilization of medical care in the Texas Workers’ Compensation System
are higher than other states with no higher-level employee satisfaction with
the care than in other states.
Basically, today all doctors can treat injured workers. Under the new law
only doctors that are certified and approved by the State will be able to treat
work related injuries. Doctors will be monitored based upon their quality and
cost-effectiveness of care.
2.
Health Care Networks will be introduced into the Texas Workers’
Compensation System. Employees will be rewarded for using the regional networks
by a shorter retroactive period to receive the first week of benefits and an
increase in the cap on the average weekly wage up to 150% of current benefits.
3.
Research also indicates that fewer Texas injured employees go
back to work compared to other states. The new law has requirements of employers
and insurance carriers to facilitate return to work for injured employees.
4.
Under current law only the wages of the employer where the employee
is hurt are used for calculating the injured employee’s average weekly wage
for lost time benefits. Under the new law all the employee’s wages, including
from other employers, will be used to calculate the average weekly wage.
This will, in some instances, increase the benefit an injured employee would
receive if they have outside or other income. This will also create an additional
burden to obtain and verify additional income.
5.
School Districts are specifically mentioned in the new law about
how their injured employees average weekly wage will be calculated. Many schools
have employees with 9-month contracts, but they are paid over a 12-month period.
Currently those employees’ average weekly wage is calculated based upon that
12-month period. Under the new law it will be calculated based upon the 9-month
contract, which in effect will make their average weekly wage higher.
The law goes on to further state that during
those months of lower/no salary that their average weekly wage can be adjusted
accordingly.
6.
The insurance carrier will now
be responsible for paying the injured employee’s attorney fees on cases where
the insurance carrier has appealed to the district court, if the insurance carrier
does not “win” the lawsuit.
7.
Return to work will now be required by both the employer and
the carrier to a level to be determined by the TWCC. This should promote a
more rapid return to work of injured employees.
8.
Pharmacy benefits will now use
a formulary for drugs, plus generic drugs will be required unless the doctor
specifies otherwise.
