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Performance Based Oversight (PBO) System Results

Section 402.075 of the Texas Labor Code mandates TDI-DWC to, at least biennially, assess the performance of insurance carriers and health care providers. Based on the performance assessment, insurance carriers and health care providers will be placed into regulatory tiers: poor performers, average performers, and consistently high performers. TDI-DWC must then focus its regulatory oversight on the poor performers. Insurance carriers will be assessed in even numbered years and health care providers will be assessed in odd numbered years.

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IC PBO Info | HCP PBO Info

Overall System Results | 2016 Insurance Carrier Results | 2017 Health Care Provider Results

PBO Overall Assessments System Results

Link to current insurance carrier methodology paper and health care provider assessment methodology paper

2016 Insurance Carrier Tier Assessments System Results

Measures Number of Insurance Carriers High Tier Performers AverageTier Performers Poor Tier Performers
All insurance carriers were assessed on the same measures 115 42 70 3

2017 Health Care Provider Tier Assessments System Results

Measures Number of Providers High Tier Performers AverageTier Performers Poor Tier Performers
DWC Form-069, Report of Medical Evaluation 152 113 30 9
Completeness of the DWC Form-073, Work Status Report 87 50 26 11
Documentation supporting why the injured employee is prevented from returning to work as reported on the DWC Form-073, Work Status Report 87 41 29 17

2016 Insurance Carrier Assessment Details

System Results

Measures Number of Insurance Carriers High Tier Performers AverageTier Performers Poor Tier Performers
All insurance carriers were assessed on the same measures 115 42 70 3

System Results PER Measure

Measures Measure Weights High Tier Performers AverageTier Performers Poor Tier Performers
Timely payment of initial Temporary Income Benefits by the insurance carrier 40% weight 35 68 12
Timely submission of Initial Payment data via EDI 10% weight 69 36 10
Timely processing of initial medical bills by the insurance carrier 30% weight 105 10 0
Timely processing of request for reconsideration medical bills by the insurance carrier 10% weight 39 32 44
Timely submission of Medical Bill Processing data via EDI 10% weight 99 12 4

Insurance Carrier Tier Placements

High Tier Performers AverageTier Performers Poor Tier Performers
ABF Freight System Inc
Alief ISD
Bitco General Insurance Corp
Bitco National Insurance Co
City of Austin
City of Dallas
City of El Paso
City of San Antonio
Corpus Christi ISD
Dallas Area Rapid Transit
Dallas ISD
Donna ISD
East Tx Educational Ins Assn
Employers Mutual Casualty Co
Employers Preferred Ins Co
Fort Worth ISD
Great West Casualty Co
Harris County
Houston ISD
Mastec Inc
Metropolitan Transit Authority Harris Co
Mitsui Sumitomo Insurance Co of America
Northside ISD
Old Glory Insurance Co
Old Republic General Insurance Corp
Plano Independent School District
Public WC Program
San Antonio ISD
Service Lloyds Insurance Co
State Office of Risk Management
Tarrant County
TASB Risk Mgmt Fund
Texas Municipal League Intergovernmental Risk Pool
Texas Mutual Insurance Co
Truck Insurance Exchange
Twin City Fire Insurance Co
Tx Assoc of Counties Rmp
Tx Public School WC Project
WC Solutions
Ysleta ISD
Zenith Insurance Co
Znat Insurance Co
Accident Fund General Insurance Co
Accident Fund Insurance Co of America
Ace American Insurance Co
American Casualty Co of Reading PA
American Interstate Insurance Co
American Zurich Insurance Co
Amerisure Insurance Co
Amerisure Mutual Insurance Co
Arch Insurance Co
Berkshire Hathaway Homestate Insurance Co
Bexar County
California Insurance Company
Charter Oak Fire Insurance Co
Chubb Indemnity Insurance Co
City of Fort Worth
City of Houston
City of Plano
Commerce & Industry Insurance Co
Deep East Texas Self Insurance Fund
Electric Insurance Co
Employers Assurance Co
Employers Insurance Co of Wausau
Farmington Casualty Co
Federal Insurance Co
Federated Service Insurance Co
Fedex Freight Inc
Fedex Ground Package System Inc
First Liberty Insurance Corp
General Motors LLC
Great American Alliance Insurance Co
Great Midwest Insurance Co
Hartford Accident & Indemnity Co
Hartford Casualty Insurance Co
Hartford Fire Insurance Co
Hartford Insurance Company of Midwest
Hartford Underwriters Insurance Co
Indemnity Insurance Co of North America
Insurance Co of the State of PA
Liberty Insurance Corp
Liberty Mutual Fire Insurance Co
LM Insurance Corp
Lockheed Martin Corp
National Interstate Insurance Co
Netherlands Insurance Co
New Hampshire Insurance Co
Old Republic Insurance Co
Pennsylvania Manufacturers Assoc I
Phoenix Insurance Co
Property & Casualty Ins Co of Hartford
Safety National Casualty Corp
Sentinel Insurance Company Ltd
Sentry Casualty Co
Sentry Insurance A Mutual Co
Standard Fire Insurance Co
Starr Indemnity & Liability Co
Superior Energy Services Inc
Texas Council Risk Management Fund
TPS Joint Self Ins Funds
Travelers Casualty & Surety Co
Travelers Casualty Ins Co of America
Travelers Indemnity Co
Travelers Indemnity Co of America
Travelers Indemnity Co of Connecticut
Travelers Property Casualty Company of America
Trumbull Insurance Co
United Airlines Inc
Valley Forge Insurance Co
XL Insurance America Inc
XL Specialty Insurance Co
Zurich American Insurance Co
Markel Insurance Co
Protective Insurance Co
Technology Insurance

2017 Health Care Provider Assessment Details per MEASURE

MEASURE - DWC Form-069, Report of Medical Evaluation

System Results

Measures Number of Providers High Tier Performers AverageTier Performers Poor Tier Performers
DWC Form-069, Report of Medical Evaluation 152 113 30 9

Tier Placements - DWC Form-069, Report of Medical Evaluation MEASURE

High Tier Performers AverageTier Performers Poor Tier Performers
Dr. Richard Wayne Adair
Dr. David Alvarado
Dr. Eradio Arredondo
Dr. Miguel Angel Arredondo
Dr. Nader Jamal Awwad
Dr. Emily Bailey
Dr. James Bales
Dr. Christopher Craig Barras
Dr. David Clark Baugher
Dr. Mark Richard Bronson
Dr. Silvio Bruna
Dr. Heather Dawn Bryce
Dr. Francis X. Burch
Dr. Charlotte Denise Burgess
Dr. Robert Elliott Canal
Dr. Richard Channing
Dr. Kelly D. Clenney
Dr. Stephanie Johnston Cohen
Dr. David Walter Coleman
Dr. Joseph Scott Coleman
Dr. Eliseo Cummings
Dr. Jeff Cunningham
Dr. Lida S. Dahm
Dr. Chris Blake Davis
Dr. John Franklin Davis
Dr. Steven A. Doores
Dr. John H. Dorsett
Dr. Brent Dale Dreier
Dr. David Allen Durkop
Dr. Donald Gene Eaves
Dr. Keven Mirk Ellis
Dr. Gary Erler
Dr. Norma Estella Esparza
Dr. Kimberly Robinson Farrington
Dr. Terence Oneal Floyd
Dr. Aaron E. Ford
Dr. Robert B. Fraser
Dr. Raymond Keith Glass
Dr. Dmitry Golovko
Dr. Karen V. Goodwin
Dr. Kyle Burk Hammes
Dr. Mark L. Hanson
Dr. Clint Hardin
Dr. Charles Wayne Hebert
Dr. Christopher Henn
Dr. Javier Samuel Hernandez
Dr. John Paul Hodges, Jr.
Dr. Crystal Hogan
Dr. Shelton G. Hopkins
Dr. Marisa Celia Inigo
Dr. Larry Ray Isbell
Dr. William K. Jackson
Dr. Al Jameson
Dr. Michael Scott Johnson
Dr. Russell Juno, III
Dr. Zvi Kalisky
Dr. Ahmed A. H. Khalifa
Dr. Jeff Alan King
Dr. Milton E. Kirkwood
Dr. Ronald Wayne Kirkwood
Dr. Amy M. Kirsch
Dr. Judith-Ann M. Knowles
Dr. Kasey Dean Kunkel
Dr. Kevin Troy Landry
Dr. Richard Burnett Lawrence, III
Dr. William Martin Lawson
Dr. Randi A. Lee
Dr. Larry Wayne Leininger
Dr. Laurence Ligon
Dr. Howard Liu
Dr. Noel Mairena
Dr. Larry Marklin
Dr. Randall Ray Mask
Dr. Steven Douglas Moore
Dr. Todd Lee Moore
Dr. Emily Jean Morales
Dr. Craig Scott Nations
Dr. James Viet Ninh
Dr. Adrian Olivares
Dr. Alyson Parrish
Dr. Warwick Leyton Payne
Dr. Thomas J. Pfeil, Jr.
Dr. Kevin Lee Prentice
Dr. Christopher Pulido
Dr. Juan Francisco Quiroz
Dr. Rafath Quraishi
Dr. Julio C. Regalado
Dr. Mark Alan Ritchie
Dr. Troy Robinson
Dr. Tom Rubio
Dr. Dean Holden Rushing
Dr. Kelley Samuel
Dr. Benjamin Andrew Savoy
Dr. Samir Sayegh
Dr. Jesse Owen Schneringer
Dr. Kevin Dykes Shrum
Dr. Sandra Silmon
Dr. John Anthony Sklar
Dr. Cecil Stehr
Dr. Derrick James Stenson
Dr. Lawrence E. Stolar
Dr. Steven Glenn Sykes
Dr. Mary Terrell
Dr. Daniel Otha Thompson, III
Dr. Michael N. Thompson
Dr. Leon Tom
Dr. Johann Van Beest
Dr. Susan Van De Water
Dr. Duane F. Vincent
Dr. Thomas Patrick Waters, III
Dr. Jason Aubrey Watkins
Dr. Lisa A. Wheeler
Dr. Joe W. Wiggins
Dr. Victor A. Abrego
Dr. Adam Alexander
Dr. Daniel C. Armstrong
Dr. Ken Arola
Dr. Christopher Ronald Blair
Dr. Mukhttar Jaffer Champsi
Dr. Norri J. Collier
Dr. Ronald Dejong
Dr. Christopher Joseph Drotar
Dr. Simon John Forster
Dr. Gabriel B. Habib, Sr.
Dr. Jay M. Harrison
Dr. Shannon Lea Hickman
Dr. Joe Hugghins
Dr. Robert Jaehne
Dr. Docc Miles Jonsson
Dr. Robert Jack Kilian
Dr. David Kuang Liang
Dr. Gilbert Mayorga, Jr.
Dr. William Meiser
Dr. Jack Paul Mitchell, Jr.
Dr. Kokila D. Naik
Dr. Justin Clive Perish
Dr. Jinger Poth
Dr. Jared C. Rosenberg
Dr. Gregory Bruce Sheppard
Dr. Edward William Smith
Dr. John Summerfield Townsend, IV
Dr. James Wetz
Dr. Dennis W. Williamson
Dr. Beth Ann Applegate
Dr. Rodney Lynn Caldwell
Dr. William Ray Culver
Dr. J. Coy Dean, II
Dr. Michael Dow
Dr. Michael Martin Leonard
Dr. Aaron Douglas Smith
Dr. Elilia Marlene Tellez
Dr. Gary Richard Williams

 

MEASURE - Completeness of the DWC Form-073, Work Status Report

System Results

Measures Number of Providers High Tier Performers AverageTier Performers Poor Tier Performers
Completeness of the DWC Form-073, Work Status Report 87 50 26 11

Tier Placements - Completeness of the DWC Form-073, Work Status Report MEASURE

High Tier Performers AverageTier Performers Poor Tier Performers
Dr. Marco L. Britton
Dr. Benjamin Bujanda
Dr. Jathan Paul Cantu
Dr. Barry Lee Cromer
Dr. Anh Tu Dang
Dr. Brandon Scott Elrod
Dr. Barnabas Talla Fote
Dr. Jose Armando Fuentes
Dr. Gerard Thomas Gabel
Dr. Alison S. Garza
Dr. David Patricio Gonzalez Gibler
Dr. Peter Edward Grays
Dr. Victor Guerrero
Dr. Richard Frederick Haenke
Dr. Warren G. Hatley, Jr.
Dr. Michael Johnathan Horoda
Dr. Nicholas Dominic Iagulli
Dr. Kerry Duane Inzer
Dr. R. Robert Ippolito
Dr. Lee Matthew Jones
Dr. Anly Joseph
Dr. Kevin Lee Kirk
Dr. Terren David Klein
Dr. Frank Charles Kretsinger
Dr. Michael Lopez
Dr. Antonio Cabrera Malbas
Dr. Peter Hyatt Marsh
Dr. Dixie P. McCrory
Dr. Edgardo Lozano Montemayor, Jr.
Dr. Bryan Novosad
Dr. Olubunmi Temitope Ogunleye
Dr. Scott Thomas Orth
Dr. Armando Quinones
Dr. Nilima Rai
Dr. Theresa Rameden
Dr. Christopher Andrew Regnier
Dr. John Albert Rochat
Dr. James Keith Rose
Dr. Peter Anthony Ruiz
Dr. Ashit I. Saheba
Dr. Steven William Schierman
Dr. Michael Paul Seeley
Dr. Darryl Lee Stinson
Dr. Arthur Larry Taitel
Dr. Nick Talarico
Dr. Richard David Trifilo
Dr. Jose Victor Vela
Dr. Andrew Lawrence Whaley
Dr. Charles Raymond Wilson
Dr. Kathryn Annette Winick
Dr. Ramiro P. Alonso
Dr. Charles William Breckenridge
Dr. Daniel Bradley Burdin
Dr. Naranath R. Chintala
Dr. Ellen Marie Dahl
Dr. James W. Galbraith
Dr. Walter Grear Hurt
Dr. Michael Gregory Kaldis
Dr. Andrew P. Kant
Dr. Roy Glenn Kreusel
Dr. Michael C. Maier
Dr. Muzaffar Mehdi
Dr. Jeffrey Dean Moffett
Dr. George John Niemirowski
Dr. Ranil Ronald Ninala
Dr. Estela Maria Perez Garay
Dr. Douglas Knox Peters
Dr. Deepalakshmi Rajakrishnan
Dr. Manouchehr Refaeian
Dr. Sergio Rodriguez
Dr. Peter Michael Sanfelippo
Dr. Cedrick Dwayne Smith
Dr. Dean Ward Smith
Dr. Durga Prasad Sunkara
Dr. Frank Harvey Swords
Dr. Christine Wyman Wan
Dr. Michael Miles Albrecht, Jr.
Dr. Robert Stanley Antonetti
Dr. David Bloome
Dr. Daniel Lee Foster
Dr. Gregory Paul Harvey
Dr. James Kevin Horn
Dr. Larry Turner Johnson
Dr. Paul Edward Kobza
Dr. James David Lowery
Dr. Jairaj Sayani
Dr. Michael Mehra Taba

MEASURE - Documentation supporting why the injured employee is prevented from returning to work as reported on the DWC Form-073, Work Status Report

System Results

Measures Number of Providers High Tier Performers AverageTier Performers Poor Tier Performers
Documentation supporting why the injured employee is prevented from returning to work as reported on the DWC Form-073, Work Status Report 87 41 29 17

Tier Placements - Documentation supporting why the injured employee is prevented from returning to work as reported on the DWC Form-073, Work Status Report MEASURE

High Tier Performers AverageTier Performers Poor Tier Performers
Dr. Marco L. Britton
Dr. Jathan Paul Cantu
Dr. Naranath R. Chintala
Dr. Ellen Marie Dahl
Dr. Anh Tu Dang
Dr. Brandon Scott Elrod
Dr. Barnabas Talla Fote
Dr. Gerard Thomas Gabel
Dr. James W. Galbraith
Dr. David Patricio Gonzalez Gibler
Dr. Victor Guerrero
Dr. Richard Frederick Haenke
Dr. Warren G. Hatley, Jr.
Dr. Michael Johnathan Horoda
Dr. Nicholas Dominic Iagulli
Dr. R. Robert Ippolito
Dr. Lee Matthew Jones
Dr. Anly Joseph
Dr. Kevin Lee Kirk
Dr. Terren David Klein
Dr. Frank Charles Kretsinger
Dr. Michael Lopez
Dr. Dixie P. McCrory
Dr. Edgardo Lozano Montemayor, Jr.
Dr. George John Niemirowski
Dr. Olubunmi Temitope Ogunleye
Dr. Scott Thomas Orth
Dr. Estela Maria Perez Garay
Dr. Armando Quinones
Dr. Deepalakshmi Rajakrishnan
Dr. Christopher Andrew Regnier
Dr. Peter Anthony Ruiz
Dr. Ashit I. Saheba
Dr. Peter Michael Sanfelippo
Dr. Steven William Schierman
Dr. Michael Paul Seeley
Dr. Darryl Lee Stinson
Dr. Michael Mehra Taba
Dr. Arthur Larry Taitel
Dr. Andrew Lawrence Whaley
Dr. Kathryn Annette Winick
Dr. Michael Miles Albrecht, Jr.
Dr. Ramiro P. Alonso
Dr. Robert Stanley Antonetti
Dr. David Bloome
Dr. Charles William Breckenridge
Dr. James Kevin Horn
Dr. Walter Grear Hurt
Dr. Kerry Duane Inzer
Dr. Andrew P. Kant
Dr. Paul Edward Kobza
Dr. Roy Glenn Kreusel
Dr. Michael C. Maier
Dr. Antonio Cabrera Malbas
Dr. Peter Hyatt Marsh
Dr. Muzaffar Mehdi
Dr. Jeffrey Dean Moffett
Dr. Ranil Ronald Ninala
Dr. Bryan Novosad
Dr. Nilima Rai
Dr. Theresa Rameden
Dr. Manouchehr Refaeian
Dr. John Albert Rochat
Dr. Sergio Rodriguez
Dr. James Keith Rose
Dr. Jairaj Sayani
Dr. Dean Ward Smith
Dr. Durga Prasad Sunkara
Dr. Richard David Trifilo
Dr. Charles Raymond Wilson
Dr. Benjamin Bujanda
Dr. Daniel Bradley Burdin
Dr. Barry Lee Cromer
Dr. Daniel Lee Foster
Dr. Jose Armando Fuentes
Dr. Alison S. Garza
Dr. Peter Edward Grays
Dr. Gregory Paul Harvey
Dr. Larry Turner Johnson
Dr. Michael Gregory Kaldis
Dr. James David Lowery
Dr. Douglas Knox Peters
Dr. Cedrick Dwayne Smith
Dr. Frank Harvey Swords
Dr. Nick Talarico
Dr. Jose Victor Vela
Dr. Christine Wyman Wan

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Last updated: 4/23/2018