DWC Adopts Amendments to MQRP
DWC adopted amendments to 28 TAC Sections 180.64, 180.66, 180.68, 180.72, and 180.76, regarding the Medical Quality Review Panel (MQRP). The amendments:
- Conform with related rules and practices.
- Clarify the amount of notice to which a respondent is entitled before an informal settlement conference (ISC).
- Clarify that DWC may conduct an ISC remotely or in person.
- Make editorial changes for plain language and agency style.
- Repeal Section 180.78 (effective date) because it is no longer necessary.
DWC Adopts Amendments to “Old Law” Settlement Agreements
DWC adopted amendments to 28 TAC Section 55.15, which implements requirements for the contents of compromise settlement agreements. The amendments remove the requirement that “old law” settlement agreements be submitted on multi-colored carbon or carbonless paper. The amendments require that “old law” settlement agreements be presented in the form and manner DWC prescribes.
DWC Adopts Amendments to Electronic Claim Data Request and Report Rule
DWC adopted amendments to 28 TAC Section 102.11(b), which implements a process for electronic exchange of data between DWC and insurance carriers as defined in Section 402.084, Labor Code to determine if workers’ compensation claims exist for individuals listed in a request for claim data. The amendment updates the website address to DWC’s current website.
DWC Adopts Amendments to Designated Doctor Procedures & Requirements; Division Required Training for Doctors
DWC adopted amendments to 28 TAC Chapter 127, Designated Doctor (DD) Procedures and Requirements, and amendments to 28 TAC Section 180.23, Division-Required Training for Doctors. The amendments include:
- Section 127.10 — provides that a DD may provide multiple certifications of maximum medical improvement and impairment ratings only when DWC directs.
- Repeals Section 127.110 — which has been incorporated into §127.100.
- Section 127.130 — updates qualification standards for DD examinations.
- Section 127.130(f) — adopted with changes made in response to a public comment, which adds a reference to the DD’s duty in Section 127.200(a)(12) to notify DWC if continuing to participate on a claim would exceed their scope of practice, to note that DWC’s assignment of a DD examination does not alter the scope of practice authorized by the DD’s professional license, and to make editorial adjustments for readability.
- Section 180.23 — amendments were necessary to remove references to recertification training requirements because amendments to Chapter 127 include a combined process for certification and renewal under Section 127.100; they also align the testing requirements for MMI and IR certifications with the updated procedures in Chapter 127.
TDI Accepts NCCI Advisory Loss Cost Filing
TDI accepted the NCCI advisory loss cost filing (SERFF tracking no. NCCI-133056154, State tracking no. S697064), with an effective date of July 1, 2022. This filing proposed an average decrease of 7.4% to the current loss cost level.
- Item 01-TX-2022-NCCI Basic Manual for Workers Compensation and Employers Liability Insurance for Texas (Basic Manual for Texas)—The workers’ compensation classification system groups employers with similar operations by classification so that loss costs and rates may be calculated to reflect overall employee exposure to injury. This filing eliminates specified Texas classifications and phraseologies and replaces them with multistate classifications to provide uniformity. NCCI proposed that the changes in Item 01-TX-2022 apply to new and renewal policies effective on or after July 1, 2023.
- Item E-1409—Enhancement to NCCI’s Experience Rating Plan Methodology— The filing revises components used in the methodology in NCCI’s Experience Rating Plan. NCCI proposed that the changes in Item E-1409 apply to experience rating modifications with rating effective dates on or after July 1, 2024. Changes to the methodology include:
- Implementing a state-specific split point of $16,500 for Texas rather than a countrywide value of $18,500. This value will change annually based on state-specific data instead of countrywide data. The split point is a threshold at which claims are divided into primary and excess losses.
- Revising the calculation of state accident limitations to reflect the 95th percentile of lost-time claims, which results in a lower cap in Texas. This would reduce the impact of a substantial claim.
- Implementing Discount ratios (D-ratios) by hazard group rather than by classification to reduce the complexity of the formula. The D-ratio is the expected percentage of losses that falls below the split point and is used to determine expected excess losses.
- Revising the calculation of the G value, which represents the state average claim severity, to make a more consistent calculation of each employer’s expected claim count.
- Recalibrating the credibility parameters underlying the weighting value (W) and ballast value (B), influencing how an employer’s actual losses impact the e-mod rating.
- Item B-1446 Revisions to NCCI’s Basic Manual, Residual Market Manual, and Forms Manual —The amendments in Item B-1446 replace the countrywide table of classifications by hazard group with a Texas-specific table. The amendments also make non-substantive changes to various rules and classifications. NCCI proposed that the changes in Item B-1446 apply to new and renewal policies effective on or after July 1, 2023.
- Item E-1410 Revisions to NCCI Manual Rules Related to the Inclusion of COVID-19 (Coronavirus) Claims in Experience Rating and Merit Rating — The filing establishes an expiration date for the special treatment of COVID-19 claims. The amendment revises rules to include COVID-19 claims with dates on or after July 1, 2023, in experience rating calculations. NCCI proposed that the changes in Item E-1410 apply to new and renewal policies effective on or after July 1, 2023.
- Item B-1447 Revisions to NCCI Manual Rules Related to the COVID-19 (Coronavirus) Pandemic – Paid Furloughed Employees and Final Premium Reporting —The filing establishes an expiration date for COVID-19 rules for paid furloughed employees. NCCI proposed that the changes in Item B-1447 apply to new and renewal policies effective on or after July 1, 2023.
- Item 01-TX-2023 Revisions to Forms Manual Forms and Endorsements Applicable in Texas and Basic Manual Rules Related to the Texas Group Purchase Program — NCCI proposed that the changes in Item 01-TX-2023 apply to new and renewal policies that are effective on or after July 1, 2023. This filing:
- Establishes the most current Federal Employers’ Liability Act Coverage Endorsement for use (WC 00 01 04 A) in Texas and withdraws the Federal Employers’ Liability Act Coverage Endorsement (WC 00 01 04);
- Updates TDI and NCCI contact information in the Texas Amendatory Endorsement;
- Eliminates the Texas—Audit Premium and Retrospective Premium Endorsement and instead adds the language to the Texas Amendatory Endorsement;
- Replaces group purchase form numbers with the form names in the Basic Manual for Texas; and
- Updates the TDI contact information in the group purchase forms.
Annual Experience and Workers’ Comp Deductible Plans
On Nov. 9, 2022, TDI issued a data call for annual experience and workers’ compensation deductible plans data used for TDI’s annual report to the governor, lieutenant governor, speaker of the house of representatives, legislature, and the public. The data call applied to all insurance companies licensed in Texas to write private passenger auto, commercial auto, homeowners’ multi-peril, workers’ compensation, commercial fire, and allied lines, residential fire and allied lines, commercial multi-peril, general liability, boiler and machinery, commercial crime, commercial glass, surety, inland marine, medical professional liability, or miscellaneous professional liability insurance.