Section 402.075 of the Texas Labor Code mandates 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. 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.
Helpful Links: PBO-Home Page | PBO-Learn More | IC PBO Info | HCP PBO Info
Overall System Results | 2020 Insurance Carrier Results | 2021 Health Care Provider Results
PBO Overall Assessments System Results
Link to current insurance carrier methodology paper and health care provider assessment methodology paper
2020 Insurance Carrier Tier Assessments System Results
| Number of Insurance Carriers | High Tier Performers | Average Tier Performers | Poor Tier Performers | |
|---|---|---|---|---|
| All insurance carriers were assessed on the same measures | 120 | 40 | 76 | 4 |
2021 Health Care Provider Tier Assessments System Results
| Number of Providers | High Tier Performers | Average Tier Performers | Poor Tier Performers | |
|---|---|---|---|---|
| DWC Form-069, Report of Medical Evaluation Category | 96 | 66 | 15 | 15 |
| DWC Form-073, Work Status Report Category | 91 | 45 | 38 | 8 |
2020 Insurance Carrier Assessment Details
System Results
| Number of Insurance Carriers | High Tier Performers | Average Tier Performers | Poor Tier Performers | |
|---|---|---|---|---|
| All insurance carriers were assessed on the same measures | 120 | 40 | 76 | 4 |
System Results PER Measure
| Measures | Measure Weights | High Tier Performers | Average Tier Performers | Poor Tier Performers |
|---|---|---|---|---|
| Timely payment of initial Temporary Income Benefits | 50% weight | 25 | 72 | 23 |
| Timely submission of Initial Payment data via EDI | 5% weight | 60 | 46 | 14 |
| Timely processing of initial medical bills | 30% weight | 115 | 5 | 0 |
| Timely processing of request for reconsideration medical bills | 10% weight | 70 | 43 | 7 |
| Timely submission of medical bill processing data via EDI | 5% weight | 109 | 9 | 2 |
Insurance Carrier Tier Placements
| High Tier Performers | Average Tier Performers | Poor Tier Performers |
|---|---|---|
| Ascension Health Alliance BITCO General Insurance Corp City of Amarillo City of Austin City of Dallas City of El Paso City of Houston City of San Antonio Deep East Texas Self Insurance Fund East Tx Educational Ins Assn El Paso ISD Federated Mutual Insurance Co Federated Reserve Insurance Co Fedex Freight Inc Fort Worth ISD Great American Alliance Insurance Co Harris County Houston ISD Incline Casualty Co Insurance Company of the West Lockheed Martin Corp Metropolitan Transit Authority Harris Co North East Independent School District Old Glory Insurance Co Property & Casualty Ins Co of Hartford Richardson ISD Sentinel Insurance Company Ltd Service Lloyds Insurance Co State Office of Risk Management TASB Risk Mgmt Fund Texas Municipal League Intergovernmental Risk Pool Texas Mutual Insurance Co Tx Assoc of Counties RMP Tx Public School WC Project UMC Health System Valley Forge Insurance Co WC Solutions Ysleta ISD Zenith Insurance Co Znat Insurance Co |
Accident Fund General Insurance Co Accident Fund Insurance Co of America Accident Fund National Insurance Co Ace American Insurance Co American Casualty Co of Reading PA American Zurich Insurance Co Amerisure Insurance Co Amerisure Mutual Insurance Co Amtrust Ins Co of Kansas Inc Arch Indemnity Insurance Co Arch Insurance Co Berkley National Insurance Co Berkshire Hathaway Homestate Insurance Co Bridgefield Casualty Insurance Co Charter Oak Fire Insurance Co Church Mutual Insurance Co City of Fort Worth Dallas Area Rapid Transit Employers Insurance Co of Wausau Employers Preferred Ins Co Farmington Casualty Co Federal Insurance Co Federated Service Insurance Co Fedex Ground Package System Inc First Liberty Insurance Corp Great West Casualty Co Hartford Casualty Insurance Co Hartford Fire Insurance Co Hartford Underwriters Insurance Co Indemnity Insurance Co of North America Insurance Co of the State of PA Lamar CISD Liberty Insurance Corp Liberty Mutual Fire Insurance Co LM Insurance Corp Markel Insurance Co Mitsui Sumitomo Insurance Co of America Monroe Guaranty Insurance Company National Union Fire Ins Co of Pittsburgh PA New Hampshire Insurance Co Norguard Insurance Co Ohio Security Insurance Co Old Republic Insurance Co Phoenix Insurance Co Plano Independent School District Protective Insurance Co QBE Insurance Corporation Redwood Fire & Casualty Ins Co RFCIC Retailers Casualty Insurance Co Safety National Casualty Corp Sentry Casualty Co Sentry Insurance A Mutual Co Sompo America Insurance Co Standard Fire Insurance Co Starbucks Corp Starr Indemnity & Liability Co Starr Specialty Insurance Co Tarrant County Technology Insurance Co 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 United Wisconsin Insurance Co Vanliner Insurance Co Wesco Insurance Co XL Insurance America Inc XL Specialty Insurance Co Zurich American Ins Co of Illinois Zurich American Insurance Co |
ACIG Insurance Co Dallas County Hospital District Everest National Insurance Co Everest Premier Insurance Co |
2021 Health Care Provider Assessment Details per Measure Categories
CATEGORY - DWC Form-069, Report of Medical Evaluation
System Results
| Measure | Number of Providers | High Tier Performers | Average Tier Performers | Poor Tier Performers |
|---|---|---|---|---|
| Timeliness of filing the DWC Form-069, Report of Medical Evaluation | 96 | 66 | 15 | 15 |
Tier Placements - DWC Form-069, Report of Medical Evaluation Category
| High Tier Performers | Average Tier Performers | Poor Tier Performers |
|---|---|---|
| Raymond Talmadge Alexander, MD Suhail S. Al-Sahli, DC David Alvarado, DC Steven Reed Anderson, DC Emily Bailey, DC James Bales, MD David Clark Baugher, DC Kirk Bradford, DC Robert Elliott Canal, DC Kelly D. Clenney, DC Joseph Scott Coleman, DC Viraf Rustom Cooper, MD Jeff Cunningham, DC Brent Allen Curtis, DC John Franklin Davis, DC Ronald Dejong, DC Brent Dale Dreier, DC Donald Gene Eaves, DC Ayodele Fadahunsi, DC Gene Jay Fields, Jr., DC Aaron E. Ford, DC Andrew Ray Garcia, Jr., DC Andrew Goodman, DC Linda Gregory, DO David Martin Griffith, DC Kyle Burk Hammes, DC Marcus Paul Hayes, DC Charles Wayne Hebert, DC Crystal Hogan, DC Joe Hugghins, DC Steven Dean Huneycutt, DC Robert Jaehne, DC Stephanie Janiak, DC Scott Jurica, DC Darla Kay Kelly, DC John Dale Kirkwood, DO Milton E. Kirkwood, DO Judith-Ann M. Knowles, DC Danny J. Kurth, DC Kevin Troy Landry, DC Richard Burnett Lawrence, III, MD Aaron Martin Levine, MD Leonard P. Lopez, DC Jack Paul Mitchell, Jr., DC Samuel Zarate Moya, DC Martin A. Munoz, DC James Christian Pitts, DC Juan Francisco Quiroz, MD Rafath Quraishi, MD Nilima Rai, MD Jared C. Rosenberg, DC Hooman Sedighi, MD Gregory Bruce Sheppard, DC John Anthony Sklar, MD Edward William Smith, DO Kenneth Steen, DC Donnel Rex Steuerwald, DC Steven Glenn Sykes, DC Neil A. Szeryk, DC Mary Terrell, MD Duane F. Vincent, DC Almaya Wadley, DC Jason Aubrey Watkins, DC Joe W. Wiggins, DC Evan Willian, DC Charles Fred Xeller, MD |
Charles Anthony Collins, DC Angela B. Cox, DC Chris Blake Davis, DC Sheri Ekukpe, DC Keven Mirk Ellis, DC Terence Oneal Floyd, DC Clint Hardin, DC James Furniss Hood, MD Pedro Julio Lozano, DC Kevin Lee Prentice, DC Robbie Rampy, MD Charles Silver, MD Corey Walter Skinner, DC Tyanna Sutton, DC |
Terry Jackman Beal, MD Suki Chapa, DC Lida S. Dahm, MD Jason Levon Eaves, DC Parvaneh Ehsanzadeh, MD Ahmed A. H. Khalifa, MD Michael Martin Leonard, MD Keith Ward Louden, MD Joyce Lyon, MD Benjamin Maurice Meshack, DC Anthony Owusu, Jr., MD Jan Riefer Petrasek, MD Valorie Robertson, MD Courtney Walls, DC Gary Richard Williams, MD |
Category - DWC Form-073, Work Status Report
System Results
| Category | Number of Providers | High Tier Performers | Average Tier Performers | Poor Tier Performers |
|---|---|---|---|---|
| DWC Form-073, Work Status Report | 91 | 45 | 38 | 8 |
| Measures | Measure Weights | Number of Providers | High Tier Performers | Average Tier Performers | Poor Tier Performers |
|---|---|---|---|---|---|
| Completeness of the DWC Form-073, Work Status Report | 30% weight | 91 | 47 | 32 | 12 |
| Documentation supporting how the injured employee’s medical condition prevents them from returning to (any) work as reported on the DWC Form-073, Work Status Report | 70% weight | 91 | 53 | 30 | 8 |
Tier Placements - DWC Form-073, Work Status Report Category
| High Tier Performers | Average Tier Performers | Poor Tier Performers |
|---|---|---|
| Sukanya Ambavaram, MD Noli Cantuba Cantuba Baldeo, MD Rosa Anna Belena-Bruce, MD Scott Barry Bischoff, MD Shamarick Gaston Blue, MD Charles William Breckenridge, MD Sonya Laneete Brock, MD Neelima Chirumamilla, MD Danielle Kay Coulter, MD Anh Tu Dang, MD John D. Dang, MD Brandon Scott Elrod, DO Savithri Hapuhennadige Fernando, MD Barnabas Talla Fote, MD Gerard Thomas Gabel, MD Majdouleen Michil Georgeos, MD David Patricio Gonzalez Gibler, MD Linda Gregory, DO Richard Frederick Haenke, DO Mark Howard Henry, MD Omer A. Ilahi, MD Michael G. Iversen, MD Anly Joseph, MD Michael Gregory Kaldis, MD Kevin Lee Kirk, DO Frank Charles Kretsinger, DO Lonniejay Latimer, MD Derek K. Lichota, MD Shauna Lyn, MD Dixie P. McCrory, MD Shannon Marie Mitchel, MD Edgardo Lozano Montemayor, Jr., MD Gregory Lane Naugher, MD Bryan J. Novosad, MD Clayton Nuelle, MD Scott Thomas Orth, MD James Robert Parker, MD Daniel H. Pham, MD Steven Clayton Riley, MD James Keith Rose, MD Penni Melissa Russo-Going, MD Rodney Kent Van Andel, MD Jose Victor Vela, MD Kathryn Annette Winick, MD Mi Mickey Yang, MD |
Kimberly Ann Abernethy, DO Michael Miles Albrecht, Jr., MD Robert Stanley Antonetti, MD Silvio Azzolini, MD Shiu-Yueh Baxter, MD Eric Frank Berkman, MD Judith Martin Cadore, MD John Choe, MD Jean Theresa Dolan, MD Michael Henry Grandison, DO Warren G. Hatley, Jr., MD David Ayrton Holland, MD Walter Grear Hurt, MD Gene Joe, DO Myron D. Jones, Jr., DO Terren David Klein, MD Louise Lamarre, MD Larry Bernard Lipscomb, MD Mathew Lynn Loewen, DO Terence Phillip Macconnell, MD Alton Marcello, MD Douglas James Mills, MD Christine Elaine Morgan, MD Son Kim Nguyen, MD Olubunmi Temitope Ogunleye, MD Enrique Porras, MD Nilima Rai, MD Theresa Rameden, MD Marshall Brooks Robert, MD Steven William Schierman, MD Ramesh Srinivasan, MD Eugene Frank Stautberg, III, MD John Summerfield Townsend, IV, MD Jose Guillermo Trevino, MD George Samuel Walls, III, MD Andrew Lawrence Whaley, MD David Juan Zehr, MD Nikola Zivaljevic, MD |
David Bloome, MD Juan Carlos Bustos, MD Andrew Paul Freese, MD Dominic Linus Gross, MD Kerry Duane Inzer, DO Guillermo Ruben Pechero, MD Joseph R. Rosiles, MD Steven J. Thornton, MD |