WORKERS' COMPENSATION UPDATE
April 2022
Doctors Under the Microscope
The DWC is seeking input for a Return-to-Work (RTW) Plan-Based Audit, which is intended to evaluate the reasonableness of a doctor’s decision and recordkeeping. The scope of the audit includes doctors who were identified as poor performers in the 2021 Health Care Provider Assessment and also those who were identified as those that billed for the DWC Form-073 that checked Part II, Box “c” preventing injured employees from returning to work.
Doctors in Trouble
Anthony Owusu, Jr., M.D. was ordered to pay an administrative penalty of $8,000 and attend recordkeeping and ethics courses for making unnecessary referrals or ordering unnecessary neuromuscular testing for injured employees. Manual muscular strength tests (MMTs) and range of motion testing is generally obtained while conducting a typical physical exam in conjunction with an initial or follow up exam by the treating clinician, but Dr. Owusu was found to have ordered or performed unnecessary MMTs inconsistent with Official Disability Guidelines (ODG).
No Double-Dipping Allowed
The Appeals Panel recently issued its first “significant” decision since September. In AP Decision 220175-s, a claimant was paid TIBs, IIBs, and SIBs through 401 weeks. A district court subsequently determined the claimant was entitled to LIBs. The ALJ concluded that the carrier could redesignate IIBs as LIBs but determined that the carrier could not do so with SIBs. The ALJ reasoned that LIBs are different from SIBs, which are payable for an inability to earn a pre-injury wage, noting the claimant could return to work and still receive LIBs. The Appeals Panel disagreed and said that redesignation is a recharacterization of the benefits paid and that the carrier was entitled to redesignate SIBs as LIBs.
Second Chance for First Responders
The deadline is fast-approaching for first responders to request that their COVID-19 claims be reconsidered. First responders whose claims were denied between March 13, 2020 and June 14, 2021 must submit a written request with the carrier to reprocess the claim no later than June 14, 2022. The DWC’s website page for first responders includes a sample request form that can be used to request a reconsideration of claims. The DWC has also prepared FAQs and other resources for first responders.
ALJ Bids Farewell
We recently learned that Administrate Law Judge (ALJ) Eric Robertson is leaving the DWC and entering into private practice. We wish him well.
A Move That's Long Overdue
DWC staff members assigned to work at the DWC headquarters on Metro Center Drive in Austin soon will be getting much-deserved new digs. Sometime this summer, they’ll be moving from the Metro Building – which sits forlornly in an industrial park near the airport and reminds us of a federal minimum security prison – to the gleaming new Barbara Jordan Building in the Capitol Complex expansion.
They’ll be joined there by TDI employees currently assigned to the William P. Hobby Building, who really deserve new digs. The Hobby Building has been in the news because of chronic water leaks, peeling paint, and pest infestations. When the Texas Tribune reviewed work orders submitted by employees working there, one work order described ants dropping from the ceiling onto an employee’s hands while she worked at her computer. Another described an employee putting on a coat at the end of the day only to see a rat jump out of the pocket.
The move can’t come soon enough. When we traveled to the Hobby Building recently to attend the hearing on TDI’s proposed changes to the workers’ compensation network rules, we saw that the building’s landscaper apparently has simply given up:
Mark Your Calendars!
DWC is hosting its health care provider and carrier quarterly meetings via Zoom on May 12, 2022. The health care provider meeting is from 9:30 a.m. to 11:00 a.m. and the carrier meeting is from 1:30 p.m. to 3:00 p.m. Here are the agendas: Health Care Provider Agenda, Carrier Agenda. These meetings provide a great opportunity for system participants to learn about the latest happenings at the Division and to provide the Division with valuable feedback. As always, we greatly appreciate the time and effort that everyone at the Division puts into these meetings.
Copyright 2022, Stone Loughlin & Swanson, LLP
You Can Make a Difference
Kids’ Chance of Texas continues to identify and provide scholarship support to children affected by a parent’s workplace injury or death. A gift to the Kids’ Chance Annual Giving Campaign ensures that every child who wants to attend college or vocational school has that opportunity. It is their dreams that your generosity supports. Please contact us if you’re interested in making a donation.
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