Can you believe it is already February of 2022? This year brings excitement and changes. The Texas Department of Insurance, Division of Workers’ Compensation (DWC) has yet to announce who will be the new Commissioner of the DWC. However, BAJB is delighted to announce the addition of LeeAnna Gainer Mask as a partner and member of its workers’ compensation team. The DWC has proposed revisions to the DWC-73 and has released the results of the health care provider PBO. It is an exciting time to be involved in Texas Workers’ Compensation.
LeeAnna Gainer Mask Joins BAJB.
LeeAnna Gainer Mask has joined BAJB as its newest partner. A native Austinite, LeeAnna’s practice began at the dinner table over conversations with her father and grandfather, Bill and J.W. Gainer. Following her graduation from Texas Tech University School of Law, LeeAnna returned to Austin and worked with Harris & Harris for four years. In October 2000, she married a South Texas cowboy, and joined Adami, Goldman and Shuffield in San Antonio. Over the next 21 years, and through various name iterations, LeeAnna represented her clients across Texas in all facets of the workers’ compensation system, including benefit disputes, medical disputes and compliance matters. LeeAnna is Board Certified, Workers’ Compensation Law by the Texas Board of Legal Specialization and former Secretary, Associate Editor, Carrier Vice-Chair and Director of the State Bar of Texas, Workers’ Compensation Section. In February 2022, LeeAnna joined BAJB as a partner.
LeeAnna and her husband, Bryan, have a daughter and a son. When not following the kids in their extracurricular endeavors, including barrel racing, breakaway roping, football and golf, they enjoy the ranch life and Texas Tech athletics.
BAJB is excited to welcome LeeAnna as a member of its workers’ compensation team.
DWC Accepting Informal Comments to the DWC-73.
The DWC is accepting public comments on proposed revisions to the DWC-73, Work Status Report. Texas Labor Code Section 402.021 provides the basic goals of the workers’ compensation system, including that each injured employee will receive services to facilitate the employee’s return to employment as soon as it is considered safe and appropriate by the employee’s health care provider. The system must also encourage the safe and timely return of injured employees to productive roles in the workplace. DWC Rule 129.5 requires health care practitioners (HCPs) to use the DWC Form-073 to document the employee’s work status and restrictions in the workplace. The updated form now requires HCPs to identify the injured employee’s job classification if work restrictions are necessary.
The revised forms are not a formal rule proposal and DWC will not treat comments as formal public comments but DWC will consider any substantive comment before adopting the revised forms. The proposed forms are on the TDI website. DWC has requested that comments on the form be submitted to RuleComments@tdi.texas.gov or mailed to: Legal Services, MC-LS
Texas Department of Insurance, Division of Workers’ Compensation, P.O. Box 12050, Austin, Texas 78711.
Comments should be submitted by 5 p.m., Central Time, on Friday, March 4, 2022.
DWC Releases Health Care Provider PBO Results.
The DWC has released the 2021 Health Care Provider Performance Based Oversight (PBO) assessment. For 2021, health care providers were assessed on their performance in one of two categories: (1) DWC-69, Report of Medical Evaluation category; and (2) DWC-73, Work Status Report category. This was the first PBO cycle using the new methodology which combined the two DWC-73, Work Status Report measures into one score.
DWC reviewed 96 health care providers for the timeliness of filing the DWC-69 (100% weight) with the following results: 66 had scores placing them in the high performer tier, 15 were in the average performer tier, and 15 had scores placing them in the poor performer tier.
DWC reviewed 91 health care providers for the completeness of the DWC-73 (30% weight) and documentation supporting how the injured employee’s medical condition prevents them from returning to (any) work as reported on the DWC-73 (70% weight) with the following results: 45 had scores placing them in the high performer tier, 38 were in the average performer tier, and 8 had scores placing them in the poor performer tier.
The 2021 PBO assessment results and a list of the health care providers that were reviewed are posted on the TDI website. If a health care provider is not listed, they were not assessed in 2021. More information on PBO and the 2021 assessment are available on the TDI website. DWC will assess insurance carriers separately in 2022.
Shoulder Surgery Plan-Based Audit.
Graves Owen, M.D., Medical Advisor to the Division of Workers’ Compensation, announced the Division has finalized its Shoulder Surgery Plan-Based Audit. The Texas Workers’ Compensation Act requires the Division of Workers’ Compensation (DWC) to review the quality of health care provided in the workers’ compensation system and take appropriate action as needed. The audit plan was developed after taking constructive input from workers’ compensation system participants. It will be interesting to see the results of the audits.
Business owner indicted for $1.1 million insurance fraud scheme.
A Houston area businessman faces multiple charges in connection with several of his corporations including Sehgal & Sons Enterprises, Ultra Building Services Inc, and Ultra Medical Cleaning & Environmental Services. It is alleged that from July 24, 2009, to August 16, 2016, Puri, of Stafford, Texas, hid employees and their payroll under other companies to lower workers’ compensation insurance premiums and obtain work contracts. The Division of Workers’ Compensation (DWC) Prosecution and Fraud Units worked closely with the affected insurance carriers, Texas Mutual Insurance Company, Service Lloyds, and Travelers. Puri was charged with securing execution of documents by deception with intent to harm or defraud. If convicted, Puri faces up to 99 years in prison.