Texas Mutual Encourages Public
to Follow Holiday Fire Safety Tips

December 22, 2008 - Between December 24 and December 26, deaths, injuries and dollar losses caused by fires increase an average of 50 percent, 61 percent and 43 percent, respectively, according to the U.S. Fire Administration.

Texas Mutual Insurance Company, the state’s leading provider of workers’ compensation insurance, encourages the public to follow these tips to reduce the chances of fire during the holidays.

Holiday lights:

  • Do not overload electrical circuits. Follow manufacturer guidelines for the number of light strands connected to each other. Do not use multiple-plug adapters to increase the number of items you can connect to a standard electrical outlet.
  • Inspect all electrical items before you use them. On light stands, look for broken or cracked light sockets, frayed or bare wires and loose connections. Make sure the ground prong on three-prong plugs is in place.
  • If you use electrical cords or lights outside, make sure they are rated for outdoor use.

Trees:

  • Make sure live trees are fresh, with no brown needles or dry limbs. Give them plenty of water.
  • Spray live trees with a fire retardant. Tree vendors and local home improvement stores usually carry fire-retardant spray.
  • Check the box and the safety tag on artificial trees to make sure they are flame-resistant. Do not place light strands on metallic trees.
  • Do not place trees near fireplaces, furnaces, candles or other sources of heat. Also, avoid placing trees near room exits. If the tree catches on fire, you may not be able to get out.

Open flames:

  • Place candles in holders that will not tip over, and keep them away from drapes, trees and other flammable objects.
  • Put candles out before you leave home or go to bed.
  • Have a professional chimney sweep inspect your fireplace annually, before you use it.
  • Light fires with kindling and wooden matches only. Do not use flammable liquids.
  • Always use a fireplace screen.

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Texas Mutual Announces Premium Fraud Indictments

December 8, 2008 - Texas Mutual Insurance Company reported today that a Travis County grand jury indicted Jeffery Haas of McKinney and Randall Estes of Allen on workers’ compensation fraud-related charges.

Haas and Estes operated a now defunct company called Toledo Landscaping and Development LLC in McKinney. The indictments allege that from December 2003 to December 2005, Haas and Estes concealed payroll and employees from Texas Mutual.

Because workers’ compensation insurance premium is based, in part, on payroll, the scheme allowed Haas and Estes to obtain a lower workers’ compensation insurance premium than Toledo owed. By hiding payroll to pay a lower premium, a company can gain an unfair advantage over competitors.

Texas Mutual notes that a grand jury indictment is a formal accusation – not a conviction – of criminal conduct.

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Fraudulent Doctor Surrenders License,
Repays $144K to Texas Mutual

December 1, 2008 - Texas Mutual Insurance Company reported today that Ihsan Shanti, M.D. of Houston and Shanti Pain & Wellness Clinic pleaded guilty to felony workers’ compensation fraud-related charges.

Between January 2003 and March 2006, Shanti and his clinic over-billed workers’ compensation carriers for pain management services in excess of hours actually attended by patients, according to the indictments.

A Travis County district court ordered Shanti to surrender his medical license for five years, pay a $10,000 fine, and repay $143,646 to Texas Mutual, $18,331 to the State Office of Risk Management, and a combined $182,500 to three other carriers.

The court also sentenced Shanti to eight years of deferred adjudication and ordered him to perform 400 hours of community service. In addition, Shanti Pain & Wellness Clinic was ordered to pay a $5,000 fine.

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Texas Mutual, NFIB Partnership
Pays Dividends for Small Businesses

November 24, 2008 - Texas Mutual Insurance Company announced a $446,998 dividend to the National Federation of Independent Business (NFIB) Safety Group for manufacturers today. The group has earned more than $542,000 in dividends since 2007, largely by controlling its workers’ compensation losses.

NFIB is the nation’s largest small-business advocate. Its Texas chapter partners with Texas Mutual to offer a Safety Group for most segments of the light-manufacturing industry.

For NFIB member L. F. Manufacturing Inc. in Giddings, the dividend was a welcome surprise in today’s troubled economy.

“These are uncertain economic times, especially for small businesses like ours,” said Chris Johnston, president and CEO of L. F. Manufacturing Inc. “We have to be prepared for whatever might happen. We’re putting our dividend right back into our business.”

Any licensed Texas agent can submit qualifying clients for membership in the NFIB manufacturing group. For more information, click here.

Texas Mutual 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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Judge Rules in Texas Mutual’s Favor,
Throws Out Claim of ‘Bad Faith’

November 18, 2008 - A judge in Guadalupe County, Texas dismissed a case alleging that Texas Mutual Insurance Company acted in “bad faith” in a workers’ compensation case involving a pre-existing medical condition.

District Court Judge W.C. Kirkendall sided with Texas Mutual in ruling that Texas Mutual established a reasonable basis for its decisions in handling the workers’ compensation claim of Charles E. Durst Jr. of Seguin, and therefore cannot be held liable for bad faith as a matter of law.

Texas Mutual paid medical and income benefits to Durst after he suffered an on-the-job injury at a New Braunfels golf course in November 2004. However, Texas Mutual contended that Durst’s work injury did not extend to a pre-existing degenerative spine condition, and therefore he was not entitled to workers’ compensation benefits for that condition, including a three-level lumbar fusion surgery. Among other evidence, Texas Mutual relied on the opinion of a board-certified orthopedic surgeon in questioning the extent of the compensable injury.

Represented by Houston plaintiff’s attorney Mike Doyle, Durst alleged that Texas Mutual acted in bad faith in this dispute.

In issuing a November 14 letter explaining his reasons for granting summary judgment in favor of Texas Mutual, Judge Kirkendall wrote that Texas Mutual could not be held liable for bad faith in its dealings with Durst. “A bona fide dispute does not rise to the level of bad faith,” the judge wrote. Judge Kirkendall noted first that Texas Mutual, in disputing the medical question involved, had relied on a doctor’s opinion; second, that five other doctors testified that the doctor’s opinion Texas Mutual relied on was reasonable; and third, that no medical expert said that the opinion that Texas Mutual relied on was in bad faith or outside the medical norm.

“We are heartened by the ruling,” Russell Oliver, president of Texas Mutual, said. “The District Court applied a key and often misunderstood part of the law – the difference between an honest difference of opinion and bad faith. When the benefits dispute turns on medical expert opinion, we have to be able to rely on a doctor’s opinion. Doctors sometimes disagree, and sometimes the Division of Workers’ Compensation agrees with the other side’s doctor. That is all that happened in this case.”

“The vast majority of workers’ compensation claims at Texas Mutual,” Mr. Oliver added, “are paid with no dispute at all. Whether the claim is a small dollar claim or a large one, our goals are to pay correctly for actual workplace injuries, help the worker recover from actual workplace injuries, and get back to work when they’re recovered from their workplace injuries.”

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Texas Mutual Insurance Gains ‘Great Victory’ In Appeals Court Case Over Hospital Bills

November 14, 2008 - Texas Mutual Insurance Company won a substantial victory Nov. 13 in a Texas appeals court case challenging an abusive pattern of questionable hospital bills for injured workers covered by workers’ compensation insurance.

The Austin Court of Appeals overturned a Travis County District Court ruling about the interpretation of a Texas Division of Workers’ Compensation guideline dealing with hospital fees.

“This Court of Appeals ruling puts a stop to questionable billing practices of certain hospitals in Texas that inflate costs in the workers’ compensation system and ultimately drive up premiums for Texas employers,” Russell Oliver, president of Texas Mutual Insurance, said.

The guideline allowed an exception to the general rule that hospitals be paid on a per diem basis for treatment of injuries involving workers’ compensation claims. The so-called “stop-loss exception,” dating back to 1997, dictated that hospital bills exceeding $40,000 in instances when services were deemed “unusually extensive” and “unusually costly” would be reimbursed at 75 percent of the billed charges.

Vista Medical Center Hospital in Pasadena, Texas, and CHRISTUS Health Gulf Coast of Houston, Texas—including CHRISTUS St. Catherine Hospital in Katy, Texas, and CHRISTUS St. John Hospital in Nassau Bay, Texas—had argued in court that they did not need to demonstrate anything more than that a bill exceeded the $40,000 threshold. The Travis County District Court agreed with the hospitals.

On Nov. 13, however, a three-judge panel of the Austin Court of Appeals unanimously overruled the lower court. The court stated that the hospitals did, in fact, need to show that a hospital stay is “unusually extensive” and “unusually costly” before they can receive a 75 percent reimbursement.

In its opinion, the Court of Appeals noted that the lower court’s interpretation of this matter led to “the absurd and unreasonable result” that reimbursement under the stop-loss exception had replaced the per diem standard.

Texas Mutual successfully argued that a system that put no restraints on hospital charges and allowed hospitals to receive 75 percent any time they chose to charge workers’ compensation insurers $40,000 or more would not be adhering to medical cost controls mandated by Texas lawmakers in 1989. Texas Mutual’s co-appellants in this case were Liberty Mutual Insurance Company, Zenith Insurance Company and Zurich American Insurance Company.

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Texas Mutual Rewards
New Policyholders With Dividends

November 10, 2008 - Texas Mutual Insurance Company announced today that it has begun distributing approximately $2 million in dividends among more than 2,700 first-year policyholders with favorable loss ratios.

The dividends represent the final component of the workers’ compensation insurer’s $150 million 2008 policyholder dividend distribution.

Texas Mutual Insurance Company has paid more than $595 million in individual policyholder dividends since 1999. The company notes that past dividends are not a guarantee of future dividends, and the Texas Department of Insurance must approve all dividends.

For more information about dividends, visit the News & Publications section at texasmutual.com.

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Claimant Sentenced in Double-Dipping Case

October 30, 2008 - Texas Mutual Insurance Company reported today that Felix Prado of Falfurrias, Texas pleaded guilty to workers’ compensation fraud-related charges.

A Travis County district court sentenced Prado to 30 days in the Travis County jail and ordered him to repay $2,791 to Texas Mutual.

Prado reported a job-related injury while working as a laborer for XXtreme Pipe Services in Houston. He claimed he was unable to work as a result of the injury, and Texas Mutual Insurance Company began paying him income benefits.

Meanwhile, Texas Mutual uncovered evidence that Prado was working as a laborer for a Porter, Texas company while receiving disability income benefits.

Investigators call this type of scam double-dipping because the claimant collects benefits for being too injured to work when he or she is gainfully employed. Texas law requires claimants to contact their workers’ comp carrier when they return to work.

Left unchecked, double-dipping and other workers’ comp fraud can lead to higher premiums for all Texas employers.

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Texas Mutual Recognizes Safe Workplaces

October 28, 2008 - Texas Mutual Insurance Company announced today that it will recognize 143 employers who share the company’s commitment to preventing workplace accidents. Premium size, loss ratio and hazard class are factors in qualifying for an award. Winners will receive either a trophy or a plaque.

David (left) and Bob Dennis of Dennis Steel earned Texas Mutual's top honor for workplace safety.

Dennis Steel in Leander is one of them. The family-owned business built its safety program on the principle that every accident is preventable.

“We do not accept on-the-job injuries as a cost of doing business,” said Bob Dennis, business manager. “We consider our employees an extension of our family. No deadline is so important that we will jeopardize any of our peoples’ safety.”

Employers who focus on safety increase their chances of qualifying for a dividend from Texas Mutual. The company distributed $150 million in dividends this year.

Corpus Christi-based Refinery Terminal Fire Company (RTFC) has earned more than $252,000 in dividends since 2003. Damien Forneris, RTFC assistant fire chief/safety officer, credits employee engagement with fueling the safety program’s long-term success.

“We have an employee safety committee that helps with all aspects of our program. We believe that if we empower employees to help develop, monitor and improve the program, they will be more committed to it,” said Forneris.

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EMT Sentenced in Double-Dipping Case

October 27, 2008 - Texas Mutual Insurance Company reported today that a Travis County district court sentenced Michael J. Rosenberg of McAllen, Texas on workers’ compensation fraud-related charges.

Rosenberg’s sentence included two years’ deferred adjudication, 100 hours of community service and a $200 fine. The court also ordered him to repay $2,821 to Texas Mutual.

Rosenberg reported a job-related injury while working as an emergency medical technician for Med-Care Emergency Medical Services in McAllen. He claimed he was unable to work as a result of the injury, and Texas Mutual Insurance Company began paying him income benefits.

Meanwhile, Texas Mutual uncovered evidence that Rosenberg was working as an emergency medical technician for another ambulance service while receiving disability income benefits.

Investigators call this type of scam double-dipping because the claimant collects benefits for being too injured to work when he or she is gainfully employed. Texas law requires claimants to contact their workers’ comp carrier when they return to work.

Left unchecked, double-dipping and other workers’ comp fraud can lead to higher premiums for all Texas employers.

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Texas Mutual Earns National
Recognition for Ease of Doing Business

October 23, 2008 - Texas Mutual Insurance Company is one of the
10 easiest carriers in the country for independent agents to do business with, according to the 6th annual Ease of Doing Business survey conducted by Deep Customer Connections (DCC) Inc. The survey also showed that no carrier delivers better insurance expertise and support than Texas Mutual.

“Workers' compensation is all we do, and we work hard to do it better than anyone else,” said Ken Lauber, vice president of field operations at
Texas Mutual.

“Our experienced underwriters help agents get prompt, appropriate coverage for their clients on the front end. From there, our loss prevention consultants help policyholders prevent accidents, and our adjusters are committed to managing claim costs.”

DCC is a Massachusetts-based company that helps property and casualty carriers make it easy for agents to work with them. This fall, DCC asked about 7,400 independent agents and brokers to evaluate more than 250 property and casualty carriers on 11 ease of doing business factors, including their track record for acting on agency needs, handling claims fairly and delivering effective technology.

Lauber adds that agents can expect more ease of doing business initiatives from Texas Mutual, particularly in the online services arena.

Agents consistently rate texasmutual.com among the best websites in the industry. The site empowers agents to get quotes, manage their book of business, review their clients’ dividend history, download custom loss runs and access claim details. Still, Lauber views the company’s online services as a work in progress.

“Agents’ needs are constantly changing, and we have to be flexible enough to respond,” said Lauber. “With agents’ feedback, we’re constantly building new online tools that empower them to spend less time on paperwork and more time building their business.”

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Hospital Group Earns First Texas Mutual Dividend

October 20, 2008 - Texas Mutual Insurance Company announced a $105,500 dividend to the Hospitals of Texas (HOTComp) workers’ compensation Safety Group today. This marks the group’s first dividend.

The group dividend was based largely on HOTComp’s overall loss ratio. Many HOTComp members have also earned individual policyholder dividends based on their individual member loss ratios.

HOTComp is open to qualifying Texas hospitals and their majority-owned subsidiary businesses.

Any licensed Texas agent can submit clients for membership. In addition to potential dividends, HOTComp members get a premium discount and access to an industry-specific safety plan.

Texas Mutual underwrites HOTComp, and the HealthSure agency administers it.

Texas Mutual 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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Medical Group Earns First Texas Mutual Dividend

October 9, 2008 - Texas Mutual Insurance Company announced a $282,592 dividend to the Texas Medical Group (TMG) discount program today. This marks the group’s first dividend.

The group dividend was based largely on TMG’s overall loss ratio. Many TMG members have also earned individual policyholder dividends based on their personal loss ratios.

TMG is open to qualifying physician offices, nursing homes and other health service providers. Any licensed Texas agent can submit clients for membership. In addition to potential dividends, TMG members get a premium discount and access to an industry-specific safety plan.

Texas Mutual underwrites TMG, and Sanford & Tatum Insurance Agency administers it.

Texas Mutual 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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Auto Dealers Earn $842K Texas Mutual Dividend

October 6, 2008 - Texas Mutual Insurance Company announced an $842,457 dividend to the Lone Star Auto Dealers Association (LSA) workers’ compensation Safety Group today. LSA has earned seven consecutive dividends totaling more than $3.1 million since 2002.

Group dividends are based largely on LSA’s overall loss ratio. Many group members have also qualified for individual policyholder dividends based on their personal loss ratios.

In addition to potential dividends, LSA members get a premium discount and access to an industry-specific safety plan. Any licensed Texas agent can submit qualifying clients for LSA membership.

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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