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Workers' Compensation Claims
Service Lloyds has handled Workers' Compensation (WC) claims in Texas since 1982. Our staff is focused on one state and the rules and regulations that govern Texas. Many of our competitors handle multiple states from one office and their adjusters must remain current on the ever changing legal environment in all those states. Our ability to focus on one state is an advantage over our competitors.
Our primary emphasis is helping injured workers recover from their injuries so they can return to their previous employment. Return to Work (RTW) is emphasized by our Marketing staff, our Loss Control staff, our Adjusters and our telephonic case managers (staff nurses, all are R.N.'s) in all their contacts with employers, medical providers, and injured workers. The nurse's goal is to make sure the injured worker understands their injury and the treatment they are receiving. She emphasizes RTW from the first contact. She will coordinate light duty restrictions with the Doctor and the employer if they are prescribed by the Doctor.
We have field investigators who coordinate our activity checks and manage our relationships with law enforcement, the National Insurance Crime Bureau, and private surveillance companies. Our fraud resistance efforts have resulted in savings of over $1,000,000 in claims that were withdrawn and we did not have to pay in each of the last two years.
Every bill that is received is audited by our medical management provider. They reduce the bill to the state approved fee schedule amount and determine if it is reasonable and if it is related to the compensable injury. They also pre-certify those procedures which require it as determined by TWCC. They assist us with peer reviews, utilization reviews and retrospective reviews as well. We also get the benefit of the PPO network they have in Texas which produces savings below the fee schedule. We also utilize their pharmacy PPO which produces additional savings on prescription drugs. Since we established this program, our medical management program has saved over $10,000,000 in medical costs each year.
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Workers' Compensation Health Care Networks
The most significant reforms to the Texas workers' compensation system since 1989 came about with the passage of House
Bill (HB) 7 by the 79th Texas Legislature. Although HB 7 impacted many aspects of the
Texas workers'compensation system, one of the most notable changes is the provision allowing carriers
to create or contract with health networks to provide health care services to
injured employees.Insurance carriers may establish or contract with workers' compensation health care networks
certified by TDI to provide health care for injured workers. Click for more details.
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