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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. The 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.





Overall System Results | 2016 Insurance Carrier Results | 2015 Health Care Provider Results

PBO Overall Assessments System Results

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

2016 Overall 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

2015 Overall Health Care Provider Tier Assessments Results

Measures Number of Providers High Tier Performers AverageTier Performers Poor Tier Performers
DWC Form-069, Report of Medical Evaluation 83 61 18 4
Completeness of the DWC Form-073, Work Status Report 124 55 38 31
Documentation supporting why the injured employee is prevented from returning to work as reported on the DWC Form-073, Work Status Report 124 62 41 21
Medical record documentation supporting the ordering of a Lumbar Spine MRI prior to 21 days from the date of injury 33 21 8 4

 


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

Overall 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

 

 

 


2015 Health Care Provider Assessment Details per MEASURE

MEASURE - DWC Form-069, Report of Medical Evaluation

Overall System Results

Measures Number of Providers High Tier Performers AverageTier Performers Poor Tier Performers
DWC Form-069, Report of Medical Evaluation 83 61 18 4

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

High Tier Performers AverageTier Performers Poor Tier Performers
Dr. Clydell Adams, Jr.
Dr. Raymond Talmadge Alexander
Dr. Michael D. Barnett
Dr. David Clark Baugher
Dr. Shelley Booker
Dr. Mark Richard Bronson
Dr. Juan J. Capello
Dr. Stephen Anthony Carter
Dr. Rick Cazares
Dr. Kelly D. Clenney
Dr. Jimmy Wade Collier
Dr. Norri J. Collier
Dr. Lida S. Dahm
Dr. Howard L. Dillard, Jr.
Dr. Steven A. Doores
Dr. Patrick Joseph Downey
Dr. Guy Kenneth Driggs, Jr.
Dr. Cesar Pierre Duclair
Dr. Jason Levon Eaves
Dr. Eugene J. Fontenot, Jr.
Dr. Raymond Keith Glass
Dr. Earl Hendrikz
Dr. Joe Hugghins
Dr. Martin R. Hullender, Jr.
Dr. Ahmed A. H. Khalifa
Dr. Joan Krajca-Radcliffe
Dr. Danny J. Kurth
Dr. Bonnie Jean Lammers
Dr. Richard Burnett Lawrence, III
Dr. Linda Sue Miller
Dr. Jack Paul Mitchell, Jr.
Dr. Gilda D. Morales
Dr. Nalini Naik
Dr. Warwick Leyton Payne
Dr. Lisa Diane Persyn
Dr. Thomas J. Pfeil, Jr.
Dr. Calvin Wayne Plumb
Dr. Jinger Poth
Dr. Christopher Pulido
Dr. Edid G. Ramos-Rivas
Dr. Stephen J. Ringel
Dr. Mark Alan Ritchie
Dr. Tom Rubio
Dr. Ramesh Shah
Dr. Sandra Silmon
Dr. John Anthony Sklar
Dr. Edward William Smith
Dr. Stephen Lynn Smith
Dr. Lawrence E. Stolar
Dr. Bruce R. Strach
Dr. Karen Sandra Thornton Suttle
Dr. Dennis Wayne Teal
Dr. Mary Terrell
Dr. Daniel Otha Thompson, III
Dr. Rollin L. Thrift
Dr. Stephen Richard Tomko
Dr. John Summerfield Townsend, IV
Dr. Jason Aubrey Watkins
Dr. David Adam West
Dr. Bruce Edward Whitehead
Dr. Jonathan E. Woodward
Dr. Eradio Arredondo
Dr. Anil Tukarampant Bangale
Dr. Deo Kalyan Bhati
Dr. Rodney Lynn Caldwell
Dr. Harparminder S. Chadha
Dr. Joseph Scott Coleman
Dr. Eliseo Cummings
Dr. James Gwyn Denton
Dr. Gabriel B. Habib,  Sr.
Dr. Robert Jaehne
Dr. Mark Edward Johnson
Dr. Gilbert Mayorga, Jr.
Dr. Robert Panzarella
Dr. Erin Silvertooth
Dr. Cecil Stehr
Dr. Susan Van De Water
Dr. Lawrence Wald
Dr. Harar Yusuf
Dr. Robert Jack Kilian
Dr. Daniel Aranda Lerma
Dr. Johann Van Beest
Dr. Lisa A. Wheeler

 

 

 



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

Overall System Results

Measures Number of Providers High Tier Performers AverageTier Performers Poor Tier Performers
Completeness of the DWC Form-073, Work Status Report 124 55 38 31

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

High Tier Performers AverageTier Performers Poor Tier Performers
Dr. Candice Lynn Addison
Dr. Charles William Breckenridge
Dr. Anh Tu Dang
Dr. Stephen Ivor Esses
Dr. Alex Flores, Jr.
Dr. Barnabas Talla Fote
Dr. Gerard Thomas Gabel
Dr. Gregory Gerald Gardner
Dr. Stephen E. Gist
Dr. Peter Edward Grays
Dr. Victor Guerrero
Dr. Richard Frederick Haenke
Dr. Michael M. Heckman
Dr. Kenneth Ezzard Holcombe
Dr. David Ayrton Holland
Dr. Michael Johnathan Horoda
Dr. Lee Matthew Jones
Dr. Andrew P. Kant
Dr. Tony Dion Keeble
Dr. Terren David Klein
Dr. Paul Edward Kobza
Dr. Frank Charles Kretsinger
Dr. Frank John Kromelis, Jr.
Dr. Derek Howard Lang
Dr. Kimberly Lawus-Scurry
Dr. David Randolph Long
Dr. Michael Lopez
Dr. Antonio Cabrera Malbas
Dr. Dixie P. McCrory
Dr. Ranil Ronald Ninala
Dr. Bryan Novosad
Dr. Olubunmi Temitope Ogunleye
Dr. Scott Thomas Orth
Dr. Paul David Pace
Dr. Rohitkumar Patel
Dr. Doreatha Jean Powell
Dr. Scott Alan Protzman
Dr. Guy Julien Racette
Dr. Nilima Rai
Dr. Christopher Andrew Regnier
Dr. Laura A. Rizzo
Dr. Peter Anthony Ruiz
Dr. Ashit I. Saheba
Dr. Steven William Schierman
Dr. Michael Paul Seeley
Dr. Kamran Shabtai
Dr. Michael Clark Smith
Dr. John George Speck
Dr. Christa Rene Springston
Dr. Arthur Larry Taitel
Dr. Steven Jackson Thornton
Dr. Jose Guillermo Trevino
Dr. Jose Victor Vela
Dr. Kathryn Annette Winick
Dr. V. P. Yitta
Dr. Rory L. Allen
Dr. Robert Stanley Antonetti
Dr. Kenneth Homer Baldwin
Dr. Rosa Anna Belena-Bruce
Dr. Robert R. Bell
Dr. Christine Ann Contreras
Dr. Barry Lee Cromer
Dr. John Daniel Diamond
Dr. Stephen Craig Drukker
Dr. Steven Robert Ellsworth
Dr. Richard Stephen Fleischer
Dr. James W. Galbraith
Dr. Robert Alexander Howard
Dr. R. Robert Ippolito
Dr. Keith Johnson
Dr. Michael Gregory Kaldis
Dr. Fredrick Wayne Kersh
Dr. James David Lowery
Dr. Michael C. Maier
Dr. Son Kim Nguyen
Dr. Avinash C. Parti
Dr. Armando Quinones
Dr. Manouchehr Refaeian
Dr. Sam N. Rostami
Dr. Kristi Jean Salinas
Dr. Peter Michael Sanfelippo
Dr. Dean Ward Smith
Dr. Eric Matthew Stehly
Dr. Durga Prasad Sunkara
Dr. Ernesto Marte Tamez, Sr.
Dr. John A. Thomas
Dr. Richard David Trifilo
Dr. Marvin E. Van Hal
Dr. Andrew Lawrence Whaley
Dr. Robert Seth Williams
Dr. Charles Raymond Wilson
Dr. Monzer Yazji
Dr. David Juan Zehr
Dr. Michael Miles Albrecht, Jr.
Dr. Ramiro P. Alonso
Dr. Neil Mahesh Badlani
Dr. James Wesley Bean
Dr. Eric Frank Berkman
Dr. David Bloome
Dr. Juan Carlos Bustos
Dr. Curtis Paul Clogston
Dr. Daniel Lee Foster
Dr. Jose Armando Fuentes
Dr. Hector Gonzalez
Dr. Gregory Paul Harvey
Dr. Walter Grear Hurt
Dr. Kerry Duane Inzer
Dr. Gene Paul Isabell, Jr.
Dr. Jeffrey Brian King
Dr. Richard Simon Levy
Dr. Benzel Christopher Macmaster
Dr. Charles Lawrence Metzger
Dr. Steven Wayne Michelsen
Dr. Jeffrey Dean Moffett
Dr. James Robert Parker
Dr. Manish Vitthalbhai Patel
Dr. James Keith Rose
Dr. Mario Alonzo Sanchez
Dr. Scott Linden Sledge
Dr. Darryl Lee Stinson
Dr. Frank Harvey Swords
Dr. Michael Mehra Taba
Dr. G. Emory Warren
Dr. Denton Watumull

 

 

 

 

 

 

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

Overall 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 124 62 41 21



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. Candice Lynn Addison
Dr. Robert Stanley Antonetti
Dr. Kenneth Homer Baldwin
Dr. Charles William Breckenridge
Dr. Anh Tu Dang
Dr. Stephen Craig Drukker
Dr. Stephen Ivor Esses
Dr. Barnabas Talla Fote
Dr. Gerard Thomas Gabel
Dr. James W. Galbraith
Dr. Gregory Gerald Gardner
Dr. Stephen E. Gist
Dr. Victor Guerrero
Dr. Richard Frederick Haenke
Dr. Michael Johnathan Horoda
Dr. Walter Grear Hurt
Dr. Kerry Duane Inzer
Dr. Lee Matthew Jones
Dr. Andrew P. Kant
Dr. Tony Dion Keeble
Dr. Terren David Klein
Dr. Paul Edward Kobza
Dr. Frank Charles Kretsinger
Dr. Frank John Kromelis, Jr.
Dr. Derek Howard Lang
Dr. Kimberly Lawus-Scurry
Dr. David Randolph Long
Dr. Michael C. Maier
Dr. Son Kim Nguyen
Dr. Ranil Ronald Ninala
Dr. Olubunmi Temitope Ogunleye
Dr. Scott Thomas Orth
Dr. Paul David Pace
Dr. Rohitkumar Patel
Dr. Doreatha Jean Powell
Dr. Scott Alan Protzman
Dr. Armando Quinones
Dr. Guy Julien Racette
Dr. Nilima Rai
Dr. Christopher Andrew Regnier
Dr. Laura A. Rizzo
Dr. Sam N. Rostami
Dr. Peter Anthony Ruiz
Dr. Ashit I. Saheba
Dr. Kristi Jean Salinas
Dr. Steven William Schierman
Dr. Michael Paul Seeley
Dr. Kamran Shabtai
Dr. John George Speck
Dr. Christa Rene Springston
Dr. Darryl Lee Stinson
Dr. Durga Prasad Sunkara
Dr. Arthur Larry Taitel
Dr. Ernesto Marte Tamez, Sr.
Dr. Jose Guillermo Trevino
Dr. Richard David Trifilo
Dr. Andrew Lawrence Whaley
Dr. Robert Seth Williams
Dr. Kathryn Annette Winick
Dr. Monzer Yazji
Dr. V. P. Yitta
Dr. David Juan Zehr
Dr. Michael Miles Albrecht, Jr.
Dr. Rory L. Allen
Dr. Ramiro P. Alonso
Dr. Neil Mahesh Badlani
Dr. Rosa Anna Belena-Bruce
Dr. Eric Frank Berkman
Dr. David Bloome
Dr. Juan Carlos Bustos
Dr. Christine Ann Contreras
Dr. John Daniel Diamond
Dr. Steven Robert Ellsworth
Dr. Richard Stephen Fleischer
Dr. Peter Edward Grays
Dr. Kenneth Ezzard Holcombe
Dr. David Ayrton Holland
Dr. Robert Alexander Howard
Dr. R. Robert Ippolito
Dr. Keith Johnson
Dr. Fredrick Wayne Kersh
Dr. Michael Lopez
Dr. James David Lowery
Dr. Benzel Christopher Macmaster
Dr. Antonio Cabrera Malbas
Dr. Dixie P. McCrory
Dr. Bryan Novosad
Dr. James Robert Parker
Dr. Avinash C. Parti
Dr. Manish Vitthalbhai Patel
Dr. Manouchehr Refaeian
Dr. James Keith Rose
Dr. Mario Alonzo Sanchez
Dr. Peter Michael Sanfelippo
Dr. Scott Linden Sledge
Dr. Dean Ward Smith
Dr. Michael Clark Smith
Dr. Eric Matthew Stehly
Dr. Steven Jackson Thornton
Dr. Marvin E. Van Hal
Dr. Jose Victor Vela
Dr. Denton Watumull
Dr. Charles Raymond Wilson
Dr. James Wesley Bean
Dr. Robert R. Bell
Dr. Curtis Paul Clogston
Dr. Barry Lee Cromer
Dr. Alex Flores, Jr.
Dr. Daniel Lee Foster
Dr. Jose Armando Fuentes
Dr. Hector Gonzalez
Dr. Gregory Paul Harvey
Dr. Michael M. Heckman
Dr. Gene Paul Isabell, Jr.
Dr. Michael Gregory Kaldis
Dr. Jeffrey Brian King
Dr. Richard Simon Levy
Dr. Charles Lawrence Metzger
Dr. Steven Wayne Michelsen
Dr. Jeffrey Dean Moffett
Dr. Frank Harvey Swords
Dr. Michael Mehra Taba
Dr. John A. Thomas
Dr. G. Emory Warren

 

MEASURE - Medical record documentation supporting the ordering of a Lumbar Spine MRI prior to 21 days from the date of injury

Overall System Results

Measures Number of Providers High Tier Performers AverageTier Performers Poor Tier Performers
Medical record documentation supporting the ordering of a Lumbar Spine MRI prior to 21 days from the date of injury 33 21 8 4


Tier Placements - Medical record documentation supporting the ordering of a Lumbar Spine MRI prior to 21 days from the date of injury MEASURE

High Tier Performers AverageTier Performers Poor Tier Performers

Dr. Rory L. Allen
Dr. Ramiro P. Alonso
Dr. Rosa Anna Belena-Bruce
Dr. James W. Galbraith
Dr. Gregory Gerald Gardner
Dr. Hector Gonzalez
Dr. Edwidge Joseph Jacinthe
Dr. Michael Gregory Kaldis
Dr. Cynthia Lee Ketterer
Dr. Frank John Kromelis, Jr.
Dr. Scott Gary Neuburger
Dr. Olubunmi Temitope Ogunleye
Dr. Doreatha Jean Powell
Dr. Nilima Rai
Dr. Laura A. Rizzo
Dr. Steven William Schierman
Dr. John George Speck
Dr. Darryl Lee Stinson
Dr. Arthur Larry Taitel
Dr. John Summerfield Townsend, IV
Dr. Richard David Trifilo

Dr. C. Lynn Anderson, Jr.
Dr. Steven Robert Ellsworth
Dr. Barnabas Talla Fote
Dr. Gilberto Garza Lozano
Dr. Bryan Novosad
Dr. James Keith Rose
Dr. Christine Wyman Wan
Dr. Charles Raymond Wilson
Dr. Eugenio Bacani
Dr. John Daniel Diamond
Dr. Kerry Duane Inzer
Dr. Kavitha Nalla

 

 

 



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Last updated: 11/03/2017

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