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Texas Monitor, 3:1 (Spring 1998)

   


   TELEMEDICINE APPLICATIONS IN THE TEXAS WORKERS' COMPENSATION SYSTEM

Telemedicine is the delivery of health care over distance using computer-based telecommunications networks. It is not a type of medical practice, but rather a method for delivering medical services. In essence, it is the movement of data rather than patients. This article examines the potential for telemedicine to bring efficiencies and enhancements to the workers' compensation system in Texas.

While telemedicine is an emerging form of medical care delivery in general medicine, it is virtually unknown in the field of workers' compensation. For this report the Research and Oversight Council on Workers' Compensation (ROC) mailed a questionnaire to all the state workers' compensation agencies, asking for information about any use of telemedicine technologies in their systems. Of the 61 percent that responded, none were involved in any applications of telemedicine for delivery of medical care to injured workers.

At first glance it may not be apparent how telemedicine could be useful in a workers' compensation system, since it is reasonable to assume that most workplaces would be concentrated rather than dispersed geographically. It is certainly true that a very large percentage of workers' compensation claims come from the major urban areas that include Dallas-Ft. Worth and Houston. However, as    Table 1 indicates, claims from workers who reside in rural counties consistently account for well over half of all claims.

According to the Texas State Board of Medical Examiners, 12 percent of the primary care physicians in Texas practice in rural areas, while 80 percent of the state is designated as rural. The result is that over 75 percent of the counties in Texas are classified as Health Professional Shortage Areas or Medically Underserved Areas. Workers injured in the rural areas of Texas face a serious shortage of health care options. This may take the form of limited access to primary care (such as a general practitioner) in the most remote areas, and limited access to specialty care in many other areas that are not necessarily considered remote.

Unique Tele-medical Applications in the Workers' Compensation System

Part of the appeal of an information technology such as telemedicine is its potential to bring efficiencies to a complex system such as the Texas workers' compensation system. Two areas of injured worker medical care where telemedicine might produce important system efficiencies are the Designated Doctor impairment rating process and the Spinal Surgery Second Opinion process.

Background: the Texas System

To compensate for some of the wages lost due to an injury, there are three basic types of income benefits:

  • Temporary Income Benefits (TIBs),
  • Impairment Income Benefits (IIBs), and
  • Supplemental Income Benefits (SIBs).

IIBs and SIBs are designed for injured workers with permanent impairments. When the injured worker has reached maximum medical improvement (MMI), the treating doctor gives an impairment rating that describes the worker's level of permanent body impairment due to the injury. The rating is based on the AMA's Guides to the Evaluation of Permanent Impairment (Third Edition, Second Printing, February 1989). An insurance carrier can also request that a doctor of its choice give an impairment rating.

Since an injured worker's impairment rating is used to calculate the amount and length of IIBs and eligibility for SIBs, the rating is often disputed. If an impairment rating is disputed by one of the parties involved, the Texas Workers' Compensation Commission (TWCC) directs the worker to be examined by a designated doctor chosen by mutual agreement of the parties. If the parties cannot agree on a designated doctor, the TWCC will assign one. The impairment rating given by the designated doctor has "presumptive weight" over previous ratings.

Problems with the Impairment Rating Process

In a 1996 study of workers with permanent impairments conducted by the ROC,1    several problem areas with the process were noted:

  • 51 percent of the workers in the sample had received more than one impairment rating, indicating that the first rating was acceptable to all parties only about half the time.
  • There was a widespread perception on the part of workers that their impairment rating was unfair because their examination had been too short, the doctor had been biased, or the doctor was not familiar with the impairment rating process.
  • Roughly one-third of the cases in the sample were involved in an administrative dispute, and the impairment rating was by far the most disputed issue.

Part of the problem is a lack of consistency in the way impairment ratings are given. This problem is compounded when the designated doctor practices in a different specialty than the treating doctor, or when he/she references a different edition of the AMA Guides other than the mandated edition. This inconsistency can lead to wide variation in the amount, length, and type of income benefits provided to injured workers with permanent impairments. An additional consequence is a large number of costly and time-consuming administrative disputes as a result of perceived bias or unfairness in the impairment rating process.

Applying Telemedicine to the Designated Doctor System

In general, telemedicine can provide increased access to medical care. In the assignment of an impairment rating by a designated doctor, however, the problem is not access to a doctor but access to the right kind of doctor, that is, a doctor familiar with workers' compensation in general and the impairment rating process in particular.

A possible application of telemedicine might entail the establishment of regional tele-medical centers within the Texas workers' compensation system. These regional centers could make available to the entire state a pool of specially trained designated doctors. These doctors would be drawn from a range of specialties and would be familiar with the impairment rating process, including the correct edition of the AMA's Guides on which the ratings are based.

In a situation where an impairment rating is disputed and a deciding opinion is necessary, a tele-medical consultation would be arranged with the TWCC designated doctor. Medical records would be transmitted electronically to t he designated doctor in advance of the consultation.

The designated doctor would conduct a general examination in a live, two-way teleconference. The injured worker would be interviewed, led through appropriate range of motion tests and other physical manipulations by the designated doctor with the aid of the treating doctor or medical professional present. Medical records and images could also be reviewed in the presence of the worker and treating doctor. A video recording of the examination would be made for future reference and documentation of procedures.

If the injured worker is not near a tele-medical site that can connect to the TWCC tele-medical center, a conventional designated doctor examination would be arranged. Likewise, if the facts of the case suggest that the situation is unusual or complex, a face-to-face consultation might be arranged instead of a tele-medical consultation.

The usefulness of this application in workers' compensation could be tested in a pilot program where the appropriate telecommunications and tele-medical infrastructure is already in place. Possible sites might include academic health centers at Texas Tech in Lubbock and the University of Texas Medical Branch (UTMB) at Galveston, which are fully capable sites that already deliver tele-medical services.

Benefits to the Designated Doctor Process

Using telemedicine in the designated doctor process could:

  • bring greater conformity to the impairment rating process;
  • minimize the problem caused by doctors who are unfamiliar with workers' compensation, the impairment rating process, or the AMA Guides;
  • reduce the range of multiple impairment ratings for the same injury, thus reducing the number of disputes;
  • increase injured worker satisfaction with the process;
  • increase collaboration among health care professionals; and
  • provide a record of the examination for follow-up and administrative purposes.

The Spinal Surgery Second Opinion Process

In medical cases where the worker's treating doctor recommends spinal surgery, both the worker and the insurance carrier have the right to obtain a second opinion.

The same telecommunications system established for the designated doctor process could be used in the area of spinal surgery second opinions, thus obtaining additional use for the same initial capital outlay. Similar system benefits would likely result from using doctors who are not only spine specialists but who are also familiar with the system, such as: greater conformity among second opinions, increased injured worker satisfaction with the process, fewer disputes, and an electronic trail of procedures followed.

Additional Benefits of Telemedicine

In addition to improving access and enhancing efficiency in the designated doctor/spinal surgery second opinion process, telemedicine can:

  • Accelerate Diagnosis and Treatment - Telemedicine allows a rural doctor to consult with a distant specialist right away, saving the patient the travel time required to visit the specialist and report back to the treating doctor. The quicker the diagnosis, the sooner treatment can begin. In the case of an injured worker, this translates to quicker return to work. In addition, for workers who are back at work but still require medical treatment, tele-medical consultations can minimize time taken from work for follow-up visits.
  • Improve Records Management - Telemedicine can reduce the time it takes to get medical records to a consulting doctor as well as the time needed to get results back. Telemedicine also facilitates integration of different kinds of records (data, images, etc.) making it easier to obtain more complete information about treatment history.
  • Improve Quality of Care - Telemedicine allows for unprecedented collaborative efforts on the part of doctor, patient, and specialist. Instead of the patient having to recount his/her medical history to the specialist and then report back to the treating doctor what the specialist said, all parties can converse together in the tele-medical consultation. Medical providers obtain critical assistance in decision-making, along with reassurance of an additional medical opinion.
  • Reduce Travel Costs - In the Texas workers' compensation system, the insurance carrier must reimburse reasonable travel expenses required for consultative medical examinations. Telemedicine can reduce travel costs for workers who are referred from a treating doctor to another doctor for second opinions or specialty care.
  • Provide Electronic Record of Treatment Program - Telemedicine consultations easily lend themselves to the formation of consistent records that can be accessed for a variety of administrative purposes, including auditing past treatment plans and protocols. All medical records in digital form (data and images) can easily be stored together in a single computer file. In cases of teleconference consults, a video recording of the examination may be available for repeat viewing or to document that certain procedures were followed. This type of evidence could be extremely useful in the workers' compensation dispute resolution process.

Cost-Benefit Analysis

Many of the costs of telemedicine -- and benefits -- are difficult to quantify. For example, a rural tele-medical consultation can enable earlier diagnosis and treatment of an illness, thus producing an overall cost savings compared to a conventional "wait and see" approach that may result in a worsening of the condition and need for patient transfer to an urban hospital. Yet, there is no way to measure that possible cost savings.

What is possible -- and frequently done -- is to compare the cost of the tele-medical consultation to the cost of sending the patient to the urban medical center. From a strict financial standpoint, it is almost always cheaper to incur the travel cost over the high capitalization costs of telemedicine technologies. This may not always be the case as the public communication network becomes more powerful and widespread, and as the costs of the necessary equipment decrease.

Cost-effectiveness is also improved when the cost can be spread over multiple uses. Another use for a telecommunications network might be for educational purposes, providing specialized training to doctors around the state about how to work with the workers' compensation system.

It is possible that cost-effectiveness will be more achievable in a workers' compensation environment than in general health care. In the present system, the designated doctor is paid $500 to conduct an examination and provide the deciding impairment rating. This cost is paid by the insurance carrier. The carrier must also reimburse for expenses when the injured worker must travel for the designated doctor exam. Using doctors under contract to TWCC -- who are working from centralized locations -- can bring many of the benefits already mentioned, while reducing some of the costs incurred in the current system.

Although it is more difficult to quantify the drain on the system caused by administrative disputes, a reduction of disputes resulting from greater conformity in the impairment rating process would greatly benefit the system overall. Improvements in this area should be factored into any analysis of effectiveness.

Barriers to Implementation

The development of telemedicine programs to date has been hindered by concerns in several areas:

  • High startup costs - including both direct and indirect costs;
  • Technological concerns - such as the rapid evolution and obsolescence of computer equipment, cost of upgrades, and compatibility issues;
  • Infrastructure issues - such as the inadequacy of telecommunications capacity in rural areas;
  • Legal issues - such as state licensing for interstate consultations and liability in terms of malpractice responsibility;
  • Privacy issues - including concern over the security of medical information transmitted electronically and unauthorized access to confidential patient records;
  • Reimbursement issues - chief of which was the fact that, until recently, most insurers did not reimburse for tele-medical services;
  • Potential for fraud and abuse - including falsifying electronic records and billing for nonexistent consultations;
  • Satisfaction and acceptance issues - especially among rural doctors and patients who may be less technologically inclined.

These are very real issues that are being addressed in many pilot telemedicine programs currently underway nationwide in the field of general health care. In general, technological development has always outpaced the societal and legal acceptance of those technologies. Many would argue that the basic mechanisms are already in place to address basic issues of licensing, liability, and fraud. Reimbursement of telemedicine was addressed in the most recent legislative session in 1997. HB 2033 requires that standard health insurance providers, including group and individual health insurance policies and HMOs, cover telemedicine services as part of a health benefit plan.

One of the excluded areas of reimbursement under HB 2033, however, is workers' compensation insurance, requiring a change in the law to implement telemedicine in the workers' compensation system. Texas workers' compensation law itself does not address telemedicine, but the law and rules need to be examined to see if there are any unintended regulatory barriers to implementation.


   STATISTICAL UPDATE ON SUPPLEMENTAL INCOME BENEFITS

Supplemental Income Benefits (SIBs) serve as wage replacement benefits for those severely injured workers who continue to have difficulty returning to work after they are no longer eligible for Temporary Income Benefits (TIBs) and Impairment Income Benefits (IIBs). This article provides updated statistical information on SIBs and addresses the following questions:

  1. Who are SIBs claimants?
  2. How many claims include SIBs?
  3. How many SIBs claimants are no longer eligible for benefits? and
  4. How frequently are SIBs entitlement issues disputed?

In order to receive SIBs, an injured worker:

  • must have an impairment rating of 15 percent or higher;
  • may not elect to receive his/her impairment income benefits in a lump sum;
  • must not have returned to work or has returned to work earning less than 80 percent of his/her average weekly wage as a direct result of an impairment caused by a compensable injury;
  • must have made a good faith effort to obtain employment commensurate with his/her ability to work.

Entitlement to SIBs is determined each quarter. The injured worker may apply to the Texas Workers' Compensation Commission (TWCC) after IIBs have ceased, and the TWCC makes an initial determination of entitlement to SIBs for the first quarter. For each subsequent quarter, the injured worker applies directly to the insurance carrier for benefits. If a SIBs claimant returns to work making at least 80 percent of his/her preinjury weekly wage, does not apply for SIBs for over a year, or is denied SIBs for four consecutive quarters, that person is no longer eligible for any future SIBs on that claim.

Who Are SIBs Claimants?

A profile of SIBs claimants was constructed by investigating the following characteristics: gender, marital status, age, job tenure, body part injured, race/ethnicity, gender, region, and impairment rating. The SIBs claimant population can be described as follows:

  • More than 70 percent of SIBs claimants are male;
  • More than three-fourths of SIBs claimants are married (76.5 percent);
  • The average age of SIBs claimants is 43 years;
  • Most claimants have been on the job less than 10 years (84 percent);
  • 34 percent of SIBs claimants are white/Caucasian and 32.5 percent are Hispanic;
  • Almost half of SIBs claimants report their back as the injured area (48.4 percent);
  • More SIBs claimants are located in South Texas (41 percent) than any other region;
  • The average impairment rating is 21 percent.

Update on the Frequency of SIBs Claims

In 1996, it was projected that there would be approximately 1,500 to 2,300 new SIBs claims per year.2    This forecast has proven true. As of December of 1997, there were 4,818 claims that included SIBs payments.3    The Research and Oversight Council on Workers Compensation reported in 1997 that between January 1, 1991 and September 31, 1996, there were 2,706 claims that included SIBs payments.4    This is an increase of 2,112 new SIBs claims in the TWCC system in a period of five quarters. It is estimated that these projections will continue to hold true through December 1998, with the prediction that approximately 7,000 cases will have entered the Texas workers' compensation system by that date.

Distribution of SIBs Claims by Year of Injury

Most SIBs claims are from injuries that occurred in 1991-1993. (See Figure 1   ). One must understand that SIBs do not start until TIBs and IIBs have ended. The start date can vary but usually occurs between the first and second year after injury. SIBs can continue until the employee returns to work, or until the statutory limit of income benefits is reached (401 weeks after the date of in jury). Because of the lag in start time, a claimant injured on December 31, 1991 could conceivably be in the SIBs phase until September 1999.

The total number of SIBs claims that are currently in the Texas system continues to increase each year. A substantial number of these however, are no longer active. Claimants who have returned to work, not applied for benefits for over a year, or have had their benefits denied for four quarters in a row are no longer eligible to receive benefits. Of the 4,818 total number of SIBs claims, 2707 are no longer active. For any given injury year, there are only 400-550 active SIBs claims. (See    Table 2.)

Update on SIBs Disputes

While the percentage of SIBs claims compared to all claims in the system is quite small (currently less than one percent), disputes involving entitlement to SIBs account for a disproportionately high number of disputes. SIBs entitlement issues accounted for 6,704 of the 54,501 disputed issues brought before Benefit Review Conferences (BRCs) in 1996, representing 12.3 percent of all issues disputed at the BRC level in 1996.

Disputes are very common for those who receive SIBs. Of the 4,818 claimants who have received SIBs, 2,970 (or 62 percent) have had SIBs entitlement disputes.    Table 3 provides a breakdown of the frequency of SIBs entitlement disputes for those 2,970 claimants.

Without completing a case by case analysis, there is no way to determine which quarter of SIBs was disputed for any given individual or whether initial entitlement or subsequent quarters are more likely to be disputed. It is very clear, however, that SIBs entitlement is much more likely to be disputed than entitlement to TIBs or IIBs.

Future articles will focus on outcomes of SIBs disputes at each level of the dispute resolution process, as well as investigating whether the type of representation that injured workers and insurance carriers utilize has an impact on the outcome of SIBs disputes.


   COMPARISON OF REPORTABLE INJURY AND LOST TIME CLAIMANTS

There are two general categories of claims in the Texas workers' compensation system:

  1. claims for injuries which result in at least eight days away from work ("lost time" claims), and
  2. claims for injuries that result in less than eight days away from work ("reportable claims").

The distinction is important because lost time claims entitle the injured worker to income benefits in addition to medical benefits. The vast majority of claims that are opened, however, are reportable claims which receive only medical benefits.

For the injured worker who does lose at least eight days of work, there are three main levels of income benefits:5   

  1. Temporary Income Benefits (TIBs) - paid for wage loss while the injured worker is healing;
  2. Impairment Income Benefits (IIBs) - paid for permanent conditions according to an adaptation schedule;
  3. Supplemental Income Benefits (SIBs) - paid for wage loss continuing after all IIBs have been paid.

Little is known about the typical characteristics of lost time and reportable claimants, even though considerable information is generated on the number of reportable and lost time claims in the Texas system.6    Additionally, little is known about the differences, if any, which may exist between these two types of claimants. Finally, we know little about how many reportable injury and lost time claimants have had disputes over the compensability of their injuries.7    This article will shed light on these issues by answering the following questions:

  • What are the typical characteristics of lost time and reportable claimants?
  • What differences, if any, can be observed between lost time and reportable claimant characteristics?
  • What percent of lost time and reportable injury claimants have had a dispute concerning the compensability of their injury?

Data

Data for this article are provided by the Texas Workers' Compensation Commission (TWCC) Dispute Resolution Information System (DRIS) and research databases. For the purposes of this study, only claimants who have not gone beyond the TIBs level are used for lost time cases. A total of 39,828 claimants who received TIBs and 100,526 claimants with a reportable injury claim were used in the analysis.

Comparison of Lost Time and Reportable Injury Claimants

   Table 4 presents a snapshot of the typical lost time and reportable injury claimants. The bold numbers in Table 4 represent the most common characteristics.

Profile: Reportable Injury Claimant

The typical reportable injury claimant is male (65.1 percent), Hispanic (33.2 percent) or White (30.6 percent), married (59.7 percent), and lives in either the southern (40.9 percent) or northern (32.7 percent) region of Texas. The average age at time of injury for reportable injury claimants is 35 years, and the typical claimant had been working for 4.2 years before the injury occurred, earning $359.00 a week. His injury is most likely to the upper extremities of the body.8    (25.3 percent), followed by the back and lower extremities.9    The nature of the injury is most likely to be a sprain or a strain (46.1 percent), followed by contusions and cuts or punctures. It is almost certain that a reportable injury claimant has not been involved in a dispute over the compensability of the injury; less than one percent (0.1 percent) of reportable injury claimants report having had the compensability of their injury disputed.

Profile: Lost Time Claimant

The profile of the lost time claimant is very similar to the profile of the reportable injury claimant. The average lost time claimant is male (66.2 percent), married (62.4 percent), and either Hispanic (34.6 percent) or White (28.6 percent). He lives in either the southern (43.7 percent) or northern region (30.9 percent) of Texas. The typical lost time claimant was 37 years of age when the injury occurred, had been working for 4.5 years at the time of injury, and earned approximately $356.00 a week on average. The most commonly injured area of the body for the lost time claimant is the back (26.5 percent), followed by lower body extremities (18.7 percent), and upper body extremities (17.7 percent). The nature of the injury is most likely a sprain or strain (57 percent), followed by contusions and cuts or punctures. It is unlikely that he was involved in a dispute over the compensability of his claim; disputes among lost time claimants occurred in only 2.6 percent of the cases.

Summary

The only notable differences between the two groups of claimants are: body area injured, the nature of the injury, and disputes concerning injury compensability. Lost time claimants are more apt to injure their backs while reportable injury claimants are more likely to injure their upper body. Sprains or strains are the most prevalent injury nature among both reportable injury and lost time claimants; however, sprains and strains account for a smaller percent among reportable injury claimants than among lost time claimants.

Disputes concerning the compensability of an injury are infrequent for both reportable injury and lost time claimants. However, the higher frequency of disputes among lost time claimants may be related to the higher frequency of back injuries within this group. Back injuries such as sprains or strains tend to be difficult to see in x-rays or MRIs, and may be more likely to result in a dispute.


   1998 RESEARCH AGENDA SET

The 1998 research agenda for the Research and Oversight Council on Workers' Compensation (ROC) was presented and approved at a meeting of the ROC board on February 19, 1998. The following projects comprise the areas that the ROC will examine this year:

  1. Workers' compensation insurance fraud
    This project examines the amount and types of fraud found in the Texas workers' compensation system. Using recent figures from TWCC and results from a survey of insurance carriers who write workers' compensation coverage in Texas, three questions were addressed:
    1. how much fraud is in the Texas workers' compensation system?
    2. how is workers' compensation fraud investigated in Texas? and
    3. how effective are California's efforts to reduce fraud and how can Texas learn from California's experiences? [Report available -- Fraud in the Texas Workers' Compensation System, Research and Oversight Council on Workers' Compensation, January 1998.]
  2. How would telemedicine impact workers' compensation?
    Telemedicine is the remote delivery of medical services over computer-based telecommunications networks. This project examines how telemedicine is currently being used in Texas and the future viability of telemedicine in the workers' compensation system. [Report available -- Telemedicine Applications in the Texas Workers' Compensation System, Research and Oversight Council on Workers' Compensation, February 1998; see article in this issue of the Monitor .]
  3. Texas Monitor articles/series
    The Texas Monitor is the quarterly report of the ROC. Articles that may appear in the Texas Monitor in 1998 include: an analysis of the dispute resolution process; a profile of the typical lost time case (see article in this issue); an update on Supplemental Income Benefits (see article in this issue); and an analysis of the most expensive types of workers' compensation claims. Additionally, summaries of ROC research studies are published in the Monitor throughout the year. [Issues 2:3, 2:4 and 3:1 [this edition] and 3:2 are all available.]
  4. What are the characteristics of an "occupational disease"?
    This project represents the first analysis of occupational disease in the Texas workers' compensation system. The completed report addressed the following questions:
    1. what are the most frequent types of occupational diseases in Texas?
    2. how much do occupational diseases cost compared to the most frequent types of injuries?
    3. how many occupational disease claims are disputed? and
    4. What industries have the highest rates of occupational disease?
  5. Analysis of a "closed claim"
    This analysis examined workers' compensation claims that have been closed by the insurance carrier to determine:
    1. the relationship of pre- and post-injury wages for injured workers;
    2. the total amount of income benefits paid on a workers' compensation claim, as well as the type of benefits received; and
    3. the total amount of medical costs paid on a claim, as well as the amounts paid to various health care providers.
  6. What happens to injured workers who were fired or laid off after their injury?
    Using a telephone survey, this project addressed the following questions:
    1. How many injured workers have been terminated as a result of a work-related injury?
    2. What accommodations are employers making to help injured workers get back to work?
    3. How many injured workers knew they had the right to choose their initial treating doctor after they were injured? and
    4. What are the financial and social outcomes of being fired or laid off after sustaining a work-related injury?
  7. Strengths and weaknesses of the workers' compensation system
    This report assessed the strengths and weaknesses of the Texas workers' compensation system. Input was obtained from the key participants in the system -- injured workers, employers, insurance carriers, health care providers, and attorneys.
  8. An Analysis of Supplemental Income Benefits (SIBs) This project examined the number of injured workers receiving SIBs; the frequency and outcome of SIBs entitlement disputes; and the number of injured workers who have lost their permanent eligibility for SIBs. In addition, a telephone survey was conducted with SIBs recipients to gather the experiences that these injured workers have had with the SIBs process including repeat entitlement disputes, timely benefit delivery, and return-to-work issues.

   ROC ANNOUNCES EXECUTIVE DIRECTOR CHANGE

After eleven years of service to the Texas workers' compensation system, Executive Director June L. Karp has announced her retirement from the ROC effective May 1, 1998.

Her replacement will be Scott McAnally, a division director at the Texas Workers' Compensation Commission. McAnally has worn many hats at the TWCC and its predecessor, the Industrial Accident Board (IAB). As executive director of the IAB during the period of workers' compensation reform, McAnally worked closely with the Legislature in crafting the new workers' compensation law in 1989 that resulted in the formation of the TWCC.

Prior to assuming the executive director position of the ROC in 1995, Ms. Karp was director of the Legislative Oversight Committee, a "watchdog" committee formed in 1989 to oversee the implementation of the new workers' compensation system. As an advisor to the Joint Select Committee on Workers' Compensation Insurance in 1988, Ms. Karp was instrumental in the effort to overhaul a highly litigious system that was experiencing rising costs to employers and decreasing benefits to injured workers.


Footnotes:

  1.    An Analysis of Texas Workers with Permanent Impairments, Research and Oversight Council on Workers' Compensation, 1996.
  2.    See Severely Injured Workers: Supplemental Income Benefits in the Texas Workers' Compensation, Research and Oversight Council on Workers' Compensation, May 1996.
  3.    This includes injuries occurring on or after January 1, 1991.
  4.    See Return-to-Work Patterns of Injured Workers Receiving Supplemental Income Benefits, Research and Oversight Council on Workers' Compensation, March 1997.
  5.    In addition to these three main income benefits, workers' compensation also provides Lifetime Income Benefits (LIBs) for certain major impairments and Death Benefits (DBs).
  6.    Texas Workers' Compensation System Data Report, Texas Workers' Compensation Commission, December 1997.
  7.    A compensable injury is defined as an "injury that arises out of the course and scope of the injured worker's employment" (Sec. 401.011, Texas Labor Code).
  8.    Upper body extremities are parts of the body such as the hand, upper arm and fingers.
  9.    Lower body extremities include the leg, ankle, thigh, and toes.

This page was last updated on December 9, 2002.


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