Spring is in the air. The weather is warmer, flowers are blooming and Texas workers’ compensation keeps rolling along. The Texas Department of Insurance, Division of Workers’ Compensation (DWC) Appeals Panel issued its first significant decision this year, addressing whether an injured worker may receive both lifetime income benefits and supplemental income benefits. The DWC’s Annual Texas Workers’ Compensation Conference is scheduled to take place, in-person, in Austin in June and BAJB is excited to be participating in the conference. A north Texas doctor has been sentenced to prison and the DWC is seeking stakeholder input for its report to the Legislature.
LIBs & SIBs – Can an Injured Worker Receive Both?
In Appeal No. 220175-s, the Appeals Panel addressed whether a self-insured/carrier could redesignate impairment income benefits (IIBs) and supplemental income benefits (SIBs) as lifetime income benefits (LIBs). The self-insured was represented by BAJB’s Mike Donovan.
An Administrative Law Judge (ALJ) determined that the self-insured could redesignate IIBs as LIBs. However, regarding SIBs, the ALJ concluded that LIBs are paid separately for specifically listed medical conditions and no express provision allowed for a reduction or elimination of benefits based on previous amounts paid for SIBs.
The Appeals Panel agreed with the ALJ that the self-insured could redesignate IIBs. However, the Appeals Panel disagreed with the ALJ and found that the self-insured could redesignate SIBs. The Appeals Panel explained that redesignation is not recoupment; rather, a redesignation is a recharacterizaiton of benefits paid. The Appeals Panel found the case analogous to the situation where a carrier pays temporary income benefits (TIBs) to an injured worker after what is later determined to be the maximum medical improvement (MMI) date. Generally, under those facts, TIBs paid after MMI are redesignated as IIBs and a carrier can take credit for the TIBs paid after MMI as IIBs. The Appeals Panel found the same should be true regarding SIBs and LIBs and that the self-insured can redesignate SIBs as LIBs.
BAJB is speaking at the Annual Texas Workers’ Compensation Conference
The DWC’s Annual Texas Workers’ Compensation Conference is scheduled to take place, in-person, in Austin, from June 27-29. Get inspired in 2022 at one of the nation’s largest workers’ compensation conferences. This year the focus is on the people and connections that make the Texas workers’ compensation system work for all participants. The Conference will explore emerging trends in health care, successful return to work strategies, partnerships in the fight against fraud, and stories of companies creating award-winning safety cultures.
BAJB’s Bob Graves and LeeAnna Mask are excited to be presenting “Defining Course and Scope of Employment in Today’s Workplace” on June 28th and 29th of the Conference.
Registration opened April 4 and Early Bird registration ends May 1. For more information, please see https://www.tdi.texas.gov/wc/events/wcconference.html.
Clinton Battle, M.D. Sentenced to 12 Years
On March 24, 2022, a U.S. district judge sentenced Clinton Battle, M.D. of Arlington to 12 years in federal prison based on a conviction and guilty plea from July 2021. Dr. Battle admitted to submitting fraudulent bills for physical therapy, office exams, and functional capacity evaluations for a period of five years starting in 2012. During that time, Dr. Battle mischaracterized services so he could bill at a higher rate. In several cases, Dr. Battle also billed for services that he claimed took longer than they actually did, were never conducted, or were conducted by unlicensed staff.
For these actions and others, including illegally issuing prescriptions for controlled substances, Dr. Battle was sentenced to a total of 144 months, with 60 months directly related to submitting fraudulent workers’ compensation medical bills. He will also have to pay $376,368 in restitution and be under supervised release for three years after his imprisonment.
The DWC Fraud Unit, the Drug Enforcement Administration’s Dallas Field Division, the U.S. Department of Labor, the U.S. Postal Service, and the IRS conducted the investigation that resulted in the conviction.
DWC Seeking Stakeholder Input
The DWC is seeking stakeholder input for legislative recommendations for the 2022 Biennial Report to the Legislature to improve the state’s ability to effectively and efficiently regulate the workers’ compensation system. Comments are due by April 29, 2022. To comment, please see: https://www.tdi.texas.gov/wc/dwc/legrecswc.html.