Most people agree that state workers’ compensation systems are highly complex, relying upon many thousands of pages of statutes, regulations, directives, interpretations and “reforms”. Some people also find Texas injury benefit plans confusing. The important thing is that both approaches to injured worker care take active steps to continually reduce complexity for injured workers, and improve medical outcomes and benefits delivery.
Texas injury benefit programs have a long history (since 1989) of non-statutory-based innovation and continuous quality improvement. For example, constructive criticisms related to the “Oklahoma Option” and Other State proposals for a workers’ comp alternative have resulted in widespread updates to Texas injury programs over the past three years, such as:
- Removing unnecessary exclusions and limitations on coverage,
- Adding “good cause” exceptions for late injury reporting and medical management requirements,
- Ensuring the injury benefit plan is the employee’s primary source of recovery, achieves better medical outcomes and pays more wage replacement (avoiding cost-shifting to government programs)
- Updates for new employee protections in ERISA disability claim regulations that became effective April 2, 2018, and
- More fiduciary training on claims handling to ensure a “full and fair review” – the legal standard approved by the U.S. Supreme Court for ERISA benefit claims.
Compliance with new legal developments, as well as other self-regulated improvements in the interests of injured workers and employers, will continue to ensure the long-term success of Texas injury benefit programs.