NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.
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.
Contact information for NWCDN members is also located on the state specific links in the event you have additional questions or your company is seeking a workers’ compensation lawyer in your state.
The annual Texas Workers’ Compensation Conference will be held
on September 29 and 30 at the Embassy Suites in San Marcos. The two-day
compensapalooza will feature a wide array of topics, from “Data Analytics:
Measuring and Managing Workers’ Compensation Outcomes” to “Leveraging Injury
Data and Predictive Analytics to Manage Claims and Propel Organizational Health
and Stability.”
On the evening of September 29 attendees can Head over to the hotel’s Spring
Lake Ballroom for the fundraiser concert, from 7:45 to 9:15 p.m. Tickets to the
show are $35.00 and benefit Kids’ Chance, a non-profit group that provides
scholarships to children of those killed or severely injured in workplace
accidents. The featured “Head”liner is native Texan Sundance Head, winner
of NBC’s The Voice in
2016. Head’s signature tune may be “Darlin’ Don’t Go,” but you should
ignore that and go anyway. To register, visit www.tdi.texas.gov/wc/events/wcconference.html.
Sundance Head: Not someone I ever thought I would find myself writing about in
this newsletter.
Copyright 2025, Stone Loughlin & Swanson, LLP
Well, it’s officially summer, and you know what that means:
murder!
Not literally, of course, but perhaps literarily. If you’ll
soon be on vacation and need a good beach read, they don’t come any beachier
than the Florida-set detective novels of John D. MacDonald. MacDonald, best
known for 1957’s The
Executioners (the basis for the movie Cape Fear) is beloved by whodunnit afficionados
for his twisty narratives, shady characters, and dialogue so hard-boiled it
should be served with toast.
For the uninitiated, a great place to start is his debut novel, The Brass Cupcake (Random
House, 1950). The title refers to the gold badge our hero, Cliff
Bartellis, once wore on the police force, since reduced to a worthless trifle
after his code of honor collided with the department’s systemic
corruption.
Now Cliff works as an insurance adjuster with the perilous specialty:
recovering stolen jewels, then paying off half the value of the policy to
whoever coughs up the goods, with a nice little commission for himself.
Except this time, the thief left something behind: the bludgeoned body of a
nice little old lady.
It seems that a $300,000.00 payout buys a lot of murder, and corpses begin
accumulating like seaweed on the Florida coast. Meanwhile, Cliff’s old
buddies on the police force are none too pleased when their former brother in
blue notices that all their suspects keep winding up in the morgue. How
long before they suspect him?
And, hey, isn’t he dating the dead lady’s niece…
But Cliff has set a trap for the perpetrator. If he can keep his cool in
the oppressive Florida heat, he might just find the killer, snag himself a tidy
bonus, and get the girl (if she doesn’t get him first). Has he got the
smarts, instincts, and courage to expose the devious double-dealing?
Of course he does. After all, he’s an insurance adjuster.
Copyright 2025, Stone Loughlin & Swanson, LLP
Like a bad penny, the Texas Legislature returns to Austin, our home town, on
January 14, and legislators already are filing bills that would significantly
alter the workers’ compensation scheme.
At least one of those bills -- SB 423 -- could upend the dispute resolution
process as we know it. Other bills would make less drastic, but still
significant, changes.
Virtual hearings
SB 423 would require the Texas Department of Insurance, Division of Workers’
Compensation (DWC) to conduct contested case hearings by telephone or
videoconference whenever the parties “mutually agree” to proceed in that
manner. This would mark a significant departure from DWC’s current practice, in
which parties are required to appear in person for nearly all contested cases
hearings.
The bill was authored by Senator Sarah Eckhardt, a lawyer and Democrat
representing Travis County. It appears generally consistent with a legislative
recommendation from DWC. As we reported last month, DWC has issued its Biennial Report to the 89th
Legislature in which, among other things, it recommended that the
legislature amend the Labor Code “to allow contested case hearings . . . by
videoconference if all parties agree to that format.”
DWC Commissioner Jeff Nelson has said that one reason for DWC’s recommendation
was to help shape a bill that appeared inevitable anyway. “[T]hat bill in one
version or another has been filed the past three sessions by parties that
weren’t us,” Nelson told lawyers at the Texas Bar Advanced Workers’
Compensation Law Seminar in August, emphasizing that a legislative change
should require both parties to agree to a virtual hearing. “Some of those
allowed the claimant to have total say on if it was going to be virtual or not
. . . [w]e had to work like crazy last session to rein in a lot of those bills
and to keep [them] somewhat reasonable.”
But the introduced version of SB 423 does not appear to contain everything that
DWC would like to see in it. Specifically, it does not contain a provision for
DWC to override the will of the parties and conduct a hearing by
videoconference even when the parties desire to proceed in person. Nelson
told lawyers at the August seminar that DWC maintains a “zero tolerance list”
of injured workers “who are combative and threatening” and DWC would like
authority to conduct a hearing by videoconference when one of the parties is a
worker on the list.
Mandatory comp for construction workers
SB 338 and its companion, HB 875, as well as HB 480, would make workers’
compensation insurance coverage mandatory for workers in the construction
industry. They would amend Labor Code section 406.096 to provide that a
construction contractor or subcontractor “shall provide workers’ compensation
insurance coverage for each employee.”
Cost-of-living adjustments for death benefit payments
HB 1292 would amend Labor Code section 408.181 to provide that the amount of a
death benefit must be adjusted each year, as necessary, to reflect inflation.
The change would apply only to claims based on an injury occurring after the
effective date of the change and it would require insurance carriers to
re-compute the amount of a death benefit each year. The amount of the
adjustment would equal the percentage increase, if any, used by the United
States Social Security Administration to provide cost-of-living adjustment for
social security payments.
First responders - Presumption of compensability of infertility
SB 454 would create a presumption that a firefighter or emergency medical
technician suffering from infertility is presumed to have developed the
infertility during the course and scope of employment.
Designated Doctor exams and assignment of IR by telemedicine
HB 1066 would amend Labor Code section 408.0041, pertaining to Designated
Doctor examinations, to allow DWC to order a Designated Doctor to conduct an
examination by telemedicine if DWC determines that conducting the exam in that
manner “is necessary to ensure access to a timely examination by a qualified
doctor.” It would require a health care professional to be physically present
in the room with the employee to assist with the examination and administer any
necessary testing.
HB 1066 also would add new Labor Code section 408.1231 to allow a doctor to
certify maximum medical improvement and assign an impairment rating by
telemedicine for many injuries. It would require a health care professional to
be physically present in the room with the employee to assist with the
examination and administer any necessary testing unless the certifying doctor
determines that the employee (1) is not at MMI or (2) has no possibility of
impairment.
Copyright 2025, Stone
Loughlin & Swanson, LLP
The DWC has hired Paul
Armstrong as an administrative law judge for the Corpus Christi field office.
Judge Armstrong’s LinkedIn page shows that his prior judicial experience
includes, among other things, over 19 years as an Administrative Law Judge for
the Social Security Administration.
Welcome, Judge Armstrong!
Copyright 2025, Stone Loughlin & Swanson, LLP
Read More
In a development that we salute, last month DWC ordered Memorial Hermann Health
System - Southeast Hospital in Dallas to pay an administrative penalty due to
the hospital’s failure to refund a payment after an insurance carrier requested
it. Consent Order 2024-8987, dated 12/03/24, highlights a tool that insurance
carriers have but seldom use to its full effect.
Specifically, Labor Code section 408.0271 and DWC Rule 133.260 allow an
insurance carrier to request a refund of a payment to a health care provider
when the carrier determines the payment was (1) an overpayment or (2) payment
for an inappropriate service. Upon receipt of the request, the health care
provider must refund the payment or file an appeal with the carrier within 45
days. If the provider appeals the carrier’s determination and the carrier
denies the appeal, the provider must refund the payment within 45 days of
notice of the denied appeal. Importantly, even if the provider requests dispute
resolution from DWC, the provider still must refund the payment to the carrier
while it pursues that remedy.
We at SLS regularly file complaints with DWC against health care providers that
have failed to refund a payment on request by our carrier clients. Our
experience has been that DWC diligently investigates such complaints and, more
often than not, providers agree to refund the payments when they learn that DWC
has opened an investigation into their refusal to do so.
Copyright 2025, Stone
Loughlin & Swanson, LLP
In yet a second
development that we applaud, last month the DWC announced that it will be
conducting an audit of the quality of Designated Doctor reports.
The Medical Quality Review
Calendar Year 2025 Annual Audit Plan, dated December 16, 2024,
states that in calendar year 2025 the Medical Quality Review Panel will conduct
one audit to evaluate “the quality of designated doctor reports and the
necessity of additional testing or referrals ordered by designated doctors to
resolve the issue in question.”
We at SLS hope that notice of the audit will cause Designated Doctors to
elevate the quality of their reports, because we see a ton of bad ones.
Copyright 2025, Stone
Loughlin & Swanson, LLP
On November 22, 2024, Commissioner Jeff Nelson released DWC’s biennial report
to the 89th Legislature providing an update on the Texas workers’ compensation
system. The biennial report includes two legislative recommendations.
One of the Commissioner’s recommendations is, essentially, a housekeeping
matter removing outdated statutory language from the Labor Code which refers to
the old Approved Doctors List (ADL).
Prior to House Bill (HB) 7, passed by the 79th Legislature in 2005 and signed
by the Governor on June 1 of that year, doctors treating injured employees in
the workers’ compensation system were required to meet specific requirements
and were registered on the Division-maintained ADL. HB 7 amended the Labor Code
to eliminate the ADL effective September 1, 2007; however, some sections of the
Labor Code still refer to the ADL. According to feedback received through
health care provider outreach, these outdated statutory references to the ADL
have resulted in confusion for some system participants who assume the old ADL
registration and training are still required. Removal of the outdated statutory
language is calculated to decrease such confusion for health care professionals
who provide health care in the workers’ compensation system.
The other recommendation, which is of greater interest to us, is the
Commissioner’s suggestion that Labor Code §410.005 be amended to allow
contested case hearings to be conducted by videoconference, if all parties
agree. According to the Division’s report, this change will enhance flexibility
and efficiency of CCHs by streamlining the administrative process, reducing
travel-related burdens, and promoting access to justice while maintaining the
integrity of the hearing process. The Division additionally anticipates the
amendment will result in improvement of access to legal representation for
injured employees living in remote areas or out of state, shortening of
timelines to resolve disputes, and improvement in injured employees’ access to
medical treatment, allowing them to return to work more quickly.
Readers may recall that CCHs were held by videoconference or telephone during
the COVID-19 breakout from March 2020, through July 2021. Based upon our
experience with videoconference and telephonic CCHs during that period, we
think CCHs conducted in that manner are less than ideal. It is not unusual that
parties or witnesses may not have access to the Zoom application or a computer.
When these parties or witnesses appear by telephone the judge is not able to
adequately observe the witnesses’ demeanor and judge the credibility of their
testimony. There may also be technical problems caused by poor cell phone
reception or speaker phones which cut in and out resulting in participants
talking over each other and being unable to hear everything that is said.
The Biennial Report goes on to outline key trends in the current workers’
compensation system to help DWC and stakeholders identify improvements to
maintain a fair and balanced workers’ compensation process. Some important key
trends identified are an 81% decrease in workers’ compensation insurance rates
since 2003; a reduction in health care costs of $338 million since 2012; and an
86% reduction in the total number of opioid prescriptions from 2009 to
2022.
You may access and review the entire report concerning the current state of the
Texas workers’ compensation system here.
Copyright 2024, Stone Loughlin & Swanson, LLP
The Division on November 14, 2024, announced it had adopted amendments to 28
Texas Administrative Code (TAC) Chapter 127, Designated Doctor Procedures and
Requirements and 28 TAC Chapter 131, Benefits - Lifetime Income Benefits. The
amendments implement HB 2468, 88th Legislature, Regular Session (2023) which
amended Texas Labor Code §408.0041 concerning Designated Doctor examinations,
and enacted Labor Code §408.1615 concerning Lifetime Income Benefits for
Certain First Responders.
You may access information concerning the amended 28 TAC §127.1 and new TAC
§127.25 here and 28 TAC §§131.1 - 131.4 and
28 TAC §§131.10 – 131.14 here.
The Division also updated the following related DWC forms:
Revised: DWC Form-032, Request for Designated Doctor Examination.
New: DWC Form-038, Application for Lifetime Income Benefits.
New: DWC Form-039, First Responder’s Annual Certification for Lifetime Income
Benefits.
Revised: DWC PLN-04, Notice of Eligibility for Lifetime Income Benefits.
Revised: DWC PLN-07, Notice of Change of Indemnity Benefit Type.
You may access the revised and new DWC Forms here.
Copyright 2024, Stone Loughlin & Swanson, LLP
Each year the Division compiles data on work-related injuries and illnesses in
Texas for the U.S. Department of Labor, Bureau of Labor Statistics. The report
released last month for 2023 reveals that Texas had a 1.8 injury and illness
rate per 100 equivalent full-time workers. This is the lowest rate for Texas in
the past 10 years and is well below the national incident rate of 2.4.
You may access the full report here.
Copyright 2024, Stone Loughlin & Swanson, LLP
The Division has announced scheduling of its next CompCourses webinar on
December 11, 2024 at 1:00 p.m. The subject is compliance in the Texas workers’
compensation system. Participants will learn the differences between a dispute
and complaint, the administrative violation process, and the lifecycle of a
fraud case. The course is free, is approved for 1 hour of TDI general education
credit, and just might keep some of us from getting into trouble!
Interested parties may register to take advantage of this valuable resource here.
Copyright 2024, Stone Loughlin & Swanson, LLP