Texas Association of
Responsible Nonsubscribers (TXANS)
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Texas Department of Insurance
Division of Workers' Compensation (DWC)

By opting out of the Texas Workers' Compensation Act, Nonsubscribers lose certain "entitlements" available to all employers insured under the Act, such as:

• "managed healthcare" services utilized by workers' compensation insurance carriers, like access to preferred provider organizations, medical case management, hospital preadmission authorization and medical bill audits.

• the Texas Department of Insurance - Division of Workers' Compensation physician and hospital medical fee guidelines (the "DWC MFG") which statutorily provide for payment substantially below the amounts most often billed by occupational medical providers.

However, Texas Healthcare Foundation ("THF") has successfully contracted with hundreds of targeted occupational medical providers for appropriate "managed healthcare" at substantial discounts off their billed charges. Unlike in workers' compensation, Nonsubscribers can direct their work-injured employees to employer designated medical providers who cooperatively render appropriate healthcare for fees comparable to the DWC MFG. For Nonsubscribers, effective medical and disability claims management (whether handled by the employer or THF) includes:

Commitment from top management to provide a safe workplace.

Straightforward, cooperative medical providers approved by the employer to provide work-injured employees appropriate medical care to expedite return to productive work.

Early intervention to immediately ascertain from the treating physician the work-injured employee's medical diagnosis, treatment plan and ability to return to regular, normal duties while incorporating "managed healthcare" services as needed.

Immediate investigation of all injuries reported to determine causes and merits of the claim. If appropriate, changes in procedures and/or equipment are implemented to prevent similar incidents in the future. Claims having litigation potential should be immediately discussed with top management and/or legal counsel.

When appropriate, coordinate with the treating physician in obtaining modified return to work for the work-injured employee. Employers realize the greatest benefits by minimizing costly paid time off and keeping the employee productive at work.

Monitor the work-injured employee's medical treatment and return to work progress until the employee can fully perform regular, normal duties. Close, continuing communication often helps THF detect problem claims that are "attitudinal" rather than medically based.

Reprice all medical bills to medically accepted guidelines and THF's contractual discounts, generating overall savings currently averaging an amazing 50%+ off billed charges!