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Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.
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The Division is about to take aim at insurance carrier peer reviewers.
The agency is in the process of creating a Peer Review Plan-Based Audit, which it says will define
the scope, methodology, and selection criteria of its review process. A draft of the Plan Based Audit
is posted it on the Division website. It says that its purpose is to:
• Promote the delivery of quality healthcare in a cost-effective manner;
• Ensure peer reviewers adhere to requirements when issuing peer review reports for extent
of injury and/or medical necessity issues;
• Ensure peer reviewers review and maintain records when performing peer review; and
• Ensure that peer reviewers hold the appropriate credentials when performing peer review.
Once the Plan-Based Audit is finalized, the Division will begin collecting and reviewing select peer
reviews that address extent of injury and medical necessity issues. It appears that the Division will
be focusing on (among other things) whether peer reviewers (1) rely on evidence-based medicine,
(2) use Division treatment guidelines, and (3) comply with Division Rule 180.28 which governs peer
review requirements, reporting, and sanctions.
The Division seeks comment from stakeholders on the current draft. Suggestions for improvement
can be emailed to OMA@tdi.texas.gov by 5 p.m. Central Time on November 4.