Texas Mutual Launches
Workers’ Comp Health Care Network

March 30, 2006 - Texas Mutual Insurance Company announced today that the Texas Department of Insurance certified its Texas Star NetworkSM on March 29, 2006. The company will begin offering the Texas Star NetworkSM option to eligible policyholders with operations in network service areas on April 3.

Eligible employers who choose a policy with the Texas Star NetworkSM option will benefit from the network system’s focus on occupational medicine. Most will also receive a network premium discount of 12 percent.

Texas Mutual Insurance Company partnered with Concentra to form the Texas Star NetworkSM option in response to House Bill 7. The bill, passed by the Texas Legislature last summer, is designed to improve quality of care, control health care costs in the state’s workers’ compensation system, and help injured workers return to productive employment. One high-profile provision of the bill allows insurance carriers to contract with or establish networks.

Injured workers who are covered by the network and live in a network service area will select their treating doctor from the Texas Star NetworkSM list of occupational health care providers. Texas Star NetworkSM case managers will work with injured workers, employers, and health care providers to facilitate appropriate and cost-effective health care and return-to-work.

“On-the-job accidents carry human and monetary costs,” said Lisa Corless, Texas Mutual® senior vice president of claim and information services. “We have created the Texas Star Network to give us additional tools to help ensure both the availability of quality medical providers and effective cost management by directing injured workers to a specialized network of right providers.”

For more information on Texas Mutual Insurance Company or the Texas Star NetworkSM option, employers should ask their agent or click here.

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Texas Mutual Introduces Online Wage Reporting

March 29, 2006 - Texas Mutual Insurance Company announced its newest tool at texasmutual.com today: DWC-3 Employers’ Wage Statement reporting. The tool reduces cumbersome paperwork and helps ensure that injured workers receive timely, accurate benefits.

The DWC-3 Employers’ Wage Statement form provides wage information that Texas Mutual Insurance Company uses to calculate injured workers’ benefits. If an employer knows that an injured employee is going to be off work or have reduced wages for eight days or more, the employer must file the form with the insurance carrier. Employers must also submit an updated DWC-3 form within seven days of any information changing from the previous wage statement.

The DWC-3 online tool prompts the employer for the required data. Once the employer has completed the online form, the system calculates the wages and sends the information directly to the adjuster handling the claim. The system also emails the employer a PDF version of the completed DWC-3 form to provide the injured worker and other appropriate parties.

To use the new tool, policyholders should:

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Prison Guard Falsifies Workers' Comp Forms

March 15, 2006 - Texas Mutual Insurance Company reported today that Lloyd Davis of Lexington pleaded guilty to workers’ compensation fraud-related charges. The Travis County 147th Judicial District Court sentenced Davis to probation and 150 hours of community service. The court also ordered Davis to pay a $500 fine and repay $8,609 in benefits he fraudulently obtained from Texas Mutual Insurance Company.

Davis suffered an on-the-job injury while working for Magnum Wireline Services. Texas Mutual Insurance Company began paying him supplemental income benefits (SIBs).

The Texas Department of Insurance, Division of Workers’ Compensation requires injured workers applying for SIBs to complete and sign a quarterly form attesting to their inability to work and reporting any earnings. Davis filed the form for three quarters. Each time, he claimed that he had earned no wages and that he was unable to work.

Meanwhile, Texas Mutual Insurance Company received information that Davis accepted a job as a prison guard. A Texas Mutual® investigation found that the SIBs forms Davis submitted were false, and that he was working at a prison before and during every quarter for which he signed the state-required form.

The Davis investigation was part of the Texas Mutual® “zero tolerance for fraud” policy. Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.

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Security Guard Indicted for Workers' Comp Fraud

March 7, 2006 - Texas Mutual Insurance Company reported today that the Travis County grand jury indicted a former Texas security guard from Grand Prairie on felony workers’ compensation fraud-related charges. The former security guard allegedly collected $3,088.80 in workers’ compensation benefits she was not entitled to receive.

Charlotte Blair reported a job-related injury while working as a security guard for Paragon Security in Arlington. Her doctor placed her in an off-work status, and Texas Mutual Insurance Company began paying her workers’ compensation income benefits.

Meanwhile, Texas Mutual Insurance Company uncovered evidence that Blair worked for another company while she collected benefits. State law requires injured workers to contact their workers’ compensation insurance carrier when they return to work.

The Blair investigation was part of the Texas Mutual® “Zero Tolerance for Fraud” policy. Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.

Note: A grand jury indictment is a formal accusation – not a conviction – of criminal conduct.

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Texas Mutual Announces Lumber
and Wood Products Safety Group

March 6, 2006 - Texas Mutual Insurance Company announced its newest workers’ compensation Safety Group today: Texas Lumber and Wood Products (TLWP). The group, which includes loggers, sawmills and window, door and casing manufacturers, will provide qualifying members with a competitive option for workers’ compensation coverage.

The Texas Department of Insurance allows employers in similar businesses to form Safety Groups to help reduce their workers’ compensation insurance premiums. TLWP is an “open” program, which means any Texas insurance agent can place qualifying clients into the group.

“TLWP is one of the few Safety Groups that serve the lumber and wood industry,” said Jim Roskopf of Guaranty Insurance Services, the group’s administrator. “These employers typically engage in fairly high-risk operations. We designed TLWP to help them improve their safety programs and save money on their workers’ compensation premiums.”

Texas Mutual Insurance Company will apply the same premium discount to each TLWP group member, regardless of its individual premium size. Members will have access to a Texas Mutual® safety plan developed specifically for their industry, and they will have the opportunity to earn potential individual and group dividends.

For more information about the Texas Lumber and Wood Products Safety Group, email Jim Roskopf or call (800) 423-3595. For a list of qualifying TLWP classification codes or for more information about Texas Mutual® Safety Groups,click here.

Past dividends are not a guarantee of future dividends, and the Texas Department of Insurance must approve all dividends.

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Trucker Indicted for Workers' Comp Fraud

February 27, 2006 - Texas Mutual Insurance Company reported today that the Travis County grand jury indicted a Spring, Texas truck driver on felony workers’ compensation fraud-related charges. The truck driver allegedly collected $16,581 in workers’ compensation benefits he was not entitled to.

Arthur Menard reported a job-related injury while working as a route driver for Better Beverages in Hallettsville. His doctor placed him in off-work status, and Texas Mutual Insurance Company began paying him workers’ compensation income benefits.

Meanwhile, Texas Mutual Insurance Company uncovered evidence that Menard worked for other trucking companies while he collected benefits. State law requires injured workers to contact their workers’ compensation insurance carrier when they return to work.

The Menard investigation was part of the Texas Mutual® “Zero Tolerance for Fraud” policy. Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.

Note: A grand jury indictment is a formal accusation – not a conviction – of criminal conduct.

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Texas Produce Association Earns $16K Dividend

February 24, 2006 - Texas Mutual Insurance Company announced a $16,447 Safety Group dividend for the Texas Produce Association (TPA) Safety Group today.

The TPA group dividend is separate from the approximately $50 million in individual dividends that Texas Mutual Insurance Company paid to qualifying policyholders in 2005. Some TPA Safety Group members may receive dividends under both programs.

TPA group members earn a premium discount based on the premium volume of the entire group, and they retain their own experience modifier. They also have access to a Texas Mutual® safety plan developed specifically for their industry.

The TPA Safety Group is open to growers, domestic shippers, import shippers, specialty shippers, distributors, and material service providers. Any agent can place a qualifying client into the group, with a Texas Mutual® underwriter’s approval. For more information on TPA and other Texas Mutual® Safety Groups, click here.

Texas Mutual Insurance Company notes that past dividends are not a guarantee of future dividends, and the Texas Department of Insurance must approve all dividends.

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Texas Schools Group Earns $34K Dividend

February 14, 2006 - Texas Mutual Insurance Company announced a $34,280 Safety Group dividend for the Texas Schools Group (TSG) today.

The TSG group dividend is separate from the approximately $50 million in individual dividends that Texas Mutual Insurance Company paid to qualifying policyholders in 2005. Some TSG members may receive dividends under both programs.

TSG Safety Group members earn a premium discount based on the premium volume of the entire group. They also have access to a Texas Mutual® safety plan developed specifically for their industry.

Any agent can place a qualifying client into the TSG Safety Group, with a Texas Mutual® underwriter’s approval. For more information on TSG and other Texas Mutual® Safety Groups, click here.

Texas Mutual Insurance Company notes that past dividends are not a guarantee of future dividends, and the Texas Department of Insurance must approve all dividends.

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Policyholder, Adjuster Recognize Red Flag for Fraud

February 13, 2006 - Texas Mutual Insurance Company reported today that Jose Gaona of Edinburg, Texas pleaded guilty to workers’ compensation fraud-related charges. The Hidalgo County Court at Law #5 sentenced Gaona to six months’ deferred probation and ordered him to repay $1466.40 in benefits to Texas Mutual Insurance Company.

Gaona reported a job-related injury while working for Gen Industrial, USA. His doctor placed him in off-work status, and Texas Mutual Insurance Company began paying him income benefits.

Gen Industrial and the adjuster assigned to the claim became suspicious because Gaona was difficult to contact while off work. Texas Mutual® fraud investigators cite this as a possible red flag for fraud. The adjuster referred the claim to the Texas Mutual Insurance Company special investigations department.

The investigation uncovered evidence proving that Gaona was earning wages with another employer while collecting workers’ compensation benefits. State law requires injured workers to contact their workers’ compensation insurance carrier when they return to work.

To help ensure injured workers understand their responsibilities under the law, Texas Mutual Insurance Company includes a note with every income benefit check reminding the injured worker to contact the adjuster as soon as he or she returns to work. Additionally, Texas Mutual® adjusters often contact claimants directly to determine their work status.

The Gaona investigation was part of the Texas Mutual® “Zero Tolerance for Fraud” policy. Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.

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Texas Mutual Internal Audit Division
Receives International Award

February 13, 2006 - The Institute of Internal Auditors has issued the Recognition of Commitment (ROC) award to the Texas Mutual Insurance Company internal audit division. The ROC is an international award recognizing internal audit teams that excel in professional excellence, quality and outreach.

The Texas Mutual® internal audit team includes certified internal auditors, certified information systems auditors, certified control self assessment facilitators, and certified public accountants who report directly to the company’s board of directors. The group is responsible for evaluating the company’s internal controls and recommending enhancements. Their goal is to help ensure that information is reliable, processes comply with company policies and external regulations, assets are protected, and operations are efficient and effective.

“With the passage of the Sarbanes-Oxley Act, more companies are recognizing the value of a strong internal audit team,” said Elliott Flood, Texas Mutual® senior vice president of internal audit. “Texas Mutual Insurance Company has always strived to operate efficiently, effectively, and above all, with integrity. Our team plays a crucial role in helping the company meet that goal, and it is an honor to be recognized by our peers.”

Texas Mutual Insurance Company is the state’s leading provider of workers’ compensation insurance. For more information, click here.

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