folio -1-folio. furthermore, if you have a last minute deadline, call our office by 3:00 p.m. and...

CLIENT NEWSLETTER BY FLAHIVE, OGDEN & LATSON

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©2004 – Flahive, Ogden & LatsonMarch 2004 Volume 9, No. 3

A Privileged Attorney-Client Communication by Flahive, Ogden & Latson

FOLFOLFOLFOLFOLFOLFOLIO

In This Issue . . .Vista Med Center LawsuitsDouble-Digit WC CostsHealing a Bad Back

p. 2p. 3p. 4

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TWCC Rule 134.650 was proposed in theTWCC public meeting on February 19, 2004. Therule basically circumvents the BRC/CCH processfor resolving these issues, and instead refers themto a prospective review medical exam (PRME)doctor.

The PRME is selected from the designateddoctor list and the PRME’s opinion “is presumedto be correct and must be upheld upon reviewunless the great weight of other evidence indicatesthe PRME opinion is incorrect.”

This proposed rule is obviously problematic.Extent of injury disputes are mixed questions offact, law, and medical opinion. Full developmentof the non-medical and medical facts is crucial.Prior history, similar complaints, mechanism ofinjury, and delay from date of injury to firstmanifestation of a symptom, are all potentiallysignificant. Some of these facts will not bedeterminable from the information provided tothe doctor.

For most cases, the doctor’s only real sourceof information would be the medical records andthe claimant’s version of how the complaint began.Of course, because there is a dispute about extentof injury, the claimant has a theory that is disputedby the carrier, and only the claimant’s version will

TWCC Proposes DDR Process forExtent of Injury Disputes

be heard by the PRME doctor. Although the PRMEdoctor is permitted to call other physicians, there is noassurance that would occur, and if it does occur, itwould probably be the treating doctor that would becalled. The point is that the PRME doctor will onlyhear one side of the story.

It is even more troublesome that chiropractorswill be actively involved in this process. Thus, a very

The Senate select committee on workers’compensation convened on Thursday, February 26,2004, and received reports from the Texas Workers’Compensation Commission.

The primary topic considered by the committeewas the feasibility of Regional Health Care Networksto be established by the Texas Workers’ CompensationCommission pursuant to the changes in House Bill2600 passed in 2001. The Senate subcommitteemembers seemed to conclude that developing a formalregional healthcare network could prove to be toodifficult. Senator Robert Duncan observed during the

continued page 14

Senate SelectCommittee on Workers'

Comp Meets


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Flahive, Ogden & Latson, a 26 lawyerfirm, defends contested workers’compensation cases statewide every day.The firm has represented insurancecompanies and employers before the TexasWorkers’ Compensation agency for morethan 50 years.

For general questions concerning thenewsletter call (512) 435-2234.

Flahive, Ogden & LatsonP.O. Box 13367

Austin Texas 78711

An electronic copy of FOLIO, our monthly clientnewsletter, is now available for clients. If you areinterested in receiving FOLIO by e-mail, please let usknow. FOLIO is prepared for the exclusive use ofFlahive, Ogden & Latson clients only. It containsprivileged communications and further sharing of thisnewsletter (in either hard copy or electronic format)outside your company without the express written consentof Flahive, Ogden & Latson is not permitted.

Our regular office hours are 8:15 a.m. to4:45 p.m.. If you need to call after 4:45,please call Patsy Shelton at (512) 435-2234.She will be on duty until 6:00 p.m. daily.DON’T WAIT UNTIL THE LAST HOUROF THE DAY FOR DEADLINE FILING.ANY FAXES WITH INFORMATION DUEMUST BE RECEIVED BY 3:30 p.m. for anydeadline handling for same day delivery tothe Commission, and faxed according to thefax directory listed on the last page ofFOLIO. Furthermore, if you have a lastminute deadline, call our office by 3:00 p.m.and speak with Tillie Aguirre or PatsyShelton to advise that a last minute filing isnecessary to meet a deadline. We will bewatching and waiting for the fax. Otherwise,last minute faxes could delay receipt. Ourlast daily run to the Commission will be at4:00 p.m., in order to get across town to meettheir 5:00 closing time.

FO&L OFFICE HOURS

Carriers handling claims in the Houston area have become wellacquainted with Vista Medical Center. The facility was used by Dr.Eric Scheffey, among other physicians. The Texas State Board ofMedical Examiners pronounced Dr. Scheffey “a real and presentdanger to the health of his patients” and suspended Dr. Scheffey’slicense. Other doctors continue to perform services at Vista MedicalCenter.

Vista is particularly well known for its very aggressive billing forinpatient admissions. The average bill is well in excess of $100,000,and the experience of this firm is that they approximate $140,000 -$150,000 on average. We recognize that we see only disputed cases,and they may submit surgical billings for amounts less than $100,000but we are skeptical. They appear to rely upon the strategy thatcarriers will apply the stop loss methodology to their usual andcustomary billings and reimburse them at 75% of billed charges. Thishospital methodology has been rejected in recent SOAH decisions –stop loss only applies for unusually extensive or costly procedures –and these charge are highly usual and routine for Vista.

Vista Medical Center has only thirty-seven beds. Per theirholding company, they average “$50,000 per inpatient procedure.”As noted at the beginning of the article, we have noted a far higherexperience in the claims that have been referred to us for review.

Furthermore, Vista reported a 43% profit margin in 2003!According to the General Accounting Office, the investigative arm ofCongress, other hospitals typically average less than 10%.

Vista was the subject of a Barron’s article in September 2003.More recently, the Healthcare Information and Management SystemSociety website posted a release on February 15, 2004 containingreports of further problems in the hospital regarding the quality of theservice provided. On February 15, 2004, the Houston Chroniclepublished a front-page story relating specifics of many of thoseincidents.

The Chronicle reported that on three separate occasions, stateinspectors recommended to the Federal Centers for Medicare andMedicaid Services that Vista’s Medicare funding be terminated, oneof the harshest penalties possible for a hospital. On each occasion,Vista was able to assure the agency that the problems had beencorrected and there was no suspension of its funding.

The Chronicle further reported that Vista Medical Center hasbeen named in at least fourteen medical malpractice lawsuits. In twoof those cases, the patients died. Most of the fourteen cases remainpending. Vista has denied the allegations in each of the cases.

With respect to these quality issues, inspectors found inadequateemergency life-saving equipment (one patient suffered serious

Vista Medical CenterSubject Of

Investigations/Lawsuits

continued on p.14


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TAB recently called for moreaggressive reform in the state’sworkers’ compensation programbased on new numbers that costsper claim grew at double-digit ratesfor the third consecutive year.

The Workers’ CompensationResearch Institute (WCRI), a non-partisan, not-for-profit researchorganization, recently announcedthat payments per claim in Texasexceeded $5,000 for 2001/2002.In a study of 12 comparison states,Texas’ costs per claim were 40percent higher than the medianstate.

WCRI also revealed that Texaschiropractors utilize a significantlarger number of visits of similarclaims than the 12-state median.

Study Reports Third Year of Double-DigitWorkers’ Compensation Costs

TAB Recommendations Will Rein in CostsIn addition, Texas

chiropractors when comparedto chiropractors in other states• Treated in 30 percent of the

claims (5-10 percent istypical)

• Received revenue/claimthat is four times higher

• Received average pricesthat are 50 percent higher.Despite higher medical

costs in Texas, workers reportsimilar or poorer outcome thanin states with lower medicalcosts and workers report similaror less satisfaction with care.

“The practice of payingmore for mediocre care muststop,” said Bill Hammond,President of the TAB.

“Flexibility over provider selection canhelp ensure that quality professionalsare giving quality care to injuredworkers.”

TAB recommends giving theemployer and/or insurer more flexibilityover physician selection to achievesignificantly lower cost and utilization.According to an earlier report by theResearch and Oversight Council onWorkers’ Compensation, sevenpercent of health care providersaccount for 80 percent of medical costs.Because only a few of the providersare driving up medical costs with highutilization, some type of employer-directed care that allows the selectionof providers to be limited could savefrom 11 to 21 percent on compensationmedical costs in Texas.

Allowing an injured worker achoice of physicians from a panel ofqualified health providers will enableemployers and insurers to cull outproviders by abusing the system whileincreasing patient satisfaction. TheWorkers’ Compensation ResearchInstitute recently documented thatdespite the fact that Texas workers’comp medical costs are the highest inthe nation, patient satisfaction is thelowest in the nation when compared toother states.

A network of high-qualityproviders will address poor patientoutcomes while reducing the cost ofcare for employers. n

ROC Publishes Final FinancialReport to Legislature

The Research and OversightCouncil on Workers' Comp-ensation (ROC) published its finalfinancial report to the StateLegislature. The report was sentto the Governor’s office on 11/20/03. The ROC was disbanded inlate August and most of itsfunctions and many of its staff weretransferred to the TexasDepartment of Insurance (TDI.)TDI has assumed theresponsibilities normally associatedwith the ROC. As such, the ROC’sfinancial report to the legislature isavailable on line from TDI’s website

at http://www.tdi.state.tx.us/general/pdf/rocafr_final.pdf.

The report contains afinancial summary of the ROCas of 08/31/03, the last day ofits operation as an independentorganization. The assignmentof the ROC to TDI is brieflydiscussed in this report. TDIwill continue to handle theresponsibilities of the ROC untilAugust, 2005. n


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Healing a Bad Back Is Often an Effort inPainful Futility

Treating back pain costsAmericans $26 billion a year, or 2.5percent of the total health care bill,according to a new study from DukeUniversity, and far more if disabilitypayments, workers' compensation andlost wages are taken into account. Thecosts are rising, researchers say, aspatients get ever more aggressive formsof treatment.

Back problems are the leadingreason for visits to neurologists andorthopedists and the eighth leadingreason for visits to doctors over all--ahead of fever, knee pain, rashes,headaches and checkups for healthybabies. More than 70 percent of adultssuffer back pain at some time in theirlives, studies show. A third have had itin the past 30 days.

Yet for all the costs, for all thehours spent in doctors' offices andoperating suites, for all the massagetherapy and acupuncture and spinalmanipulations, study after study isleading medical experts to ask what, ifanything, is doing any good.

A variety of studies have suggestedthat in 85 percent of cases it isimpossible to say why a person's backhurts, said Dr. Richard Deyo, aprofessor of medicine and healthservices at the University ofWashington. And most of the time, thepain goes away with or without medicaltreatment.

"Nearly everyone gets better,nearly everyone improves," said Dr.Deyo, citing evidence from largeepidemiological studies. But hecautioned, "Getting better doesn'tnecessarily mean pain-free."

"For a small number of patients,"he added, "surgery can offer quickrelief, although even then it is commonto have mild symptoms andrecurrences."

The Duke researchers, led by Dr.

Xeumei Luo, used national data from1998. Back pain expenses, they say,included $11.1 billion for office visits;$4.5 billion for hospitalization; $3.9billion for prescription drugs; $4.7billion for outpatient services; and$1.1 billion for emergency room care,with the rest made up of such things asmedical devices. The total, $26 billion,was a 30 percent increase of 1977after adjusting for inflation.

"It's not like there's an explosionof new back pain," said Dr. StevenAtlas, an assistant professor ofmedicine at Harvard Medical School,who investigates back treatments. "Thenumber of cases isn't increasing; thecost per case is increasing. There is alot more that is being done, but theissue is, Is it helping or not?"

Back pain has always been around,like headaches, or the common cold.What has changed, doctors say, arepeople's expectations.

"People say, 'I'm not going to putup with it,'" Dr. Deyo said. "And we inthe medical profession have turned toever more aggressive medications,narcotic medications, surgery, moreinvasive surgery."

But studies find little evidencethat patients are better off for all thetreatment.

Researchers asked, for example,what is the meaning of diskabnormalities, so often seen when aback patient undergoes an magneticresonance imaging, or M.R.I.? So theyexamined people with no back pain.One study, of 98 people, found thattwo-thirds had problems like bulgingor protruding disks, herniated disksand degenerated disks. A third hadmore than one abnormal disk.

Sometimes a problem like aherniated, or ruptured, disk causes thepain, and surgery can relieve it, saidthe study's author, Dr. Michael N.

Brant-Zawadzki, a radiologist at HoagHospital in Newport Beach, Calif.But usually, he added, it may be m orecoincidence than cause and effect whenan M.R.I. finds an abnormal disk insomeone with back pain. And evenwhen a herniated disk causes the pain,the problem often goes away by itself.

It is easy to see the appeal of anM.R.I., said Dr. Stanley J. Bigos, anemeritus professor of orthopedicsurgery and environmental health atthe University of Washington. "Thereality is, patients want an answer, thedoctor wants to get the patient out ofthe room , and the hypotheses start toflow."

Other studies have indicated thatthe development of abnormal disks isusually inherited. But there were nolinks to occupation, sports injuries orweak muscles, said Dr. Nortin Hadler,a professor of medicine at theUniversity of North Carolina.

Researchers then asked whetherpatients who have M.R.I.'s do anybetter.

In a study published last year inthe Journal of the American MedicalAssociation, Dr. Deyo and hiscolleagues randomly assigned 380patients with back pain to x-rays orM.R.I.'s. X-rays can reveal tumors orfractures but not abnormal disks.

Half the M.R.I. patients had diskabnormalities, and the imagingpatients, as a group, ended up withmore intensive treatment--more doctorvisits, physical therapy, acupuncture,and chiropractic manipulations as wellas more surgery. And while they werehappier with their care, they fared nobetter than the x-ray patients. Withina few months, most patients in eachgroup were feeling better and wereback at work. continued on p. 15


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The International Association ofIndustrial Accident Boards andCommittees (IAIABC) will hostseveral seminars of interest to Texasinsurance carriers. Of importance,and EDI seminar will be given onApril 28th and 29th in Orlando, Florida.

The ACC is a three-day event

The TWCC’s TXCOMP systemhas created a new term in reportingcriteria. Currently, carriers reportinformation via EDI to the TWCC inthe manner of fields that are“mandatory,” “conditional,” or“optional.” The TWCC will begin tocollect information via EDI that willbe jurisdictionally “required.” Thedata will be “required” by the TWCCfor a variety of reasons (compliancereviews, data research, etc.)

The fields of interest are found inthe EDI 148 report. They include thefollowing data numbers/elements:DN 16 Employer FEINDN 25 Industry Code (NAICS)DN 28 Policy NumberDN 29 Policy EffectiveDN 30 Policy ExpirationDN 35 Nature of Injury CodeDN 36 Part of Body Part InjuredCodeDN 37 Cause of Injury CodeDN 38 Accident DescriptionDN 52 Employee Date of Birth

The TWCC is interested in theseelements in order for them to satisfystatutory data collection and reportingrequirements, to accurately linkclaims to their correct policies, andfor critical downstream processes towork correctly.

If a carrier fails to report thisinformation in the initial EDI 148report, the TWCC will notify thecarrier that the report has been flagged

for system monitoring and reportingcompliance. THE DESIGNATION“REQUIRED” WILL NOT REJECTANY EDI TRANSACTIONS. TheTWCC’s new computer system(TXCOMP) will flag EDI-148s thatlack these “required” data fields andgenerate a follow-up request to thecarrier to provide the missing data.The request for this information will bemade at thirty-day intervals until theinformation is provided to the TWCC.The claim will also be flagged by theTWCC for system monitoring andreporting compliance.

Additionally, the TWCC hasannounced that DN 56 (Date DisabilityBegan) will also be modified in thefuture. The modification will allowfuture electronic reporting of “medicalonly” claims. It will also allow theTWCC to accurately associate medicalonly claims to medical billing datacurrently being collected by the TWCC.The data element will be classified as“conditional” unless benefits are beinginitiated; at which time if becomesmandatory. The claim type “MedicalOnly” should be applied in such cases.

The effective date for the new“required” information and data elementchanges will be September seventh,2004. Please contact the TWCC’s BPIProject Team for fur therinformation about these changes inEDI reporting. n

TXCOMP System Requires NewChanges to Claims Reporting

IAIABC to Hold EDI Training Seminarswhere the IAIABC Committees meetand discuss current projects and setgoals and initiatives for the next year.Committee work is an integral part ofthe organization, because it providesfor workers’ compensationprofessionals to share information andinsight about the practical problems

faced in administrating workers’compensation laws. Committee workrelays these discussions into researchand the production of papers that arevaluable to all workers’ compensationprofessionals.

The EDI seminars in Orlando willinclude EDI 101, 201, 301 and POC.Information about this seminar can befound at the following link: http://www.iaiabc.org/Conferences/2004_acc/acc_2004_edi_training.pdf

The IAIABC recommends theirEDI seminars for carrier employeesthat work in the areas of reporting,information technology (specificallyin the area of EDI,) and insurancecompany internal policy development.Because of the fluid nature of EDIregulation and format, periodic EDItraining for managers and informationtechnology/information reportingemployees is recommended.

Meetings of the EDI Systems,Claims, Implementation, Medical, andProof of Coverage Committees andthe EDI Council will be held inconjunction with the IAIABC AllCommittee Conference at the RadissonResort Parkway in Kissimmee, FLfrom April 25 – May 1, 2004. TheImplementation Committee will alsopresent a full round of EDI training onWednesday, April 28 and Thursday,April 29. For more information,including registration materials, pleasesee the IAIABC website at http://www.iaiabc.org/Conferences/2004_acc/2004_acc_index.htm n

CARF FACILITIES

Remember that preauth is notrequired for a program initiated prior toJanuary 1, 2004. Do not denyreimbursement based upon lack ofpreauth. TWCC will issueadministrative violations per Advisory2003-22.


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Q

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Here are several of the most significant generalquestions ( and answers) asked of FO&L attorneysthis month.

CornerQG

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Claimant wants clarification from a designateddoctor. The designated doctor is no longer on theADL, and therefore I believe no longer on the

designated doctor list. As long as the designated doctorcan answer the questions posed, can he continue to serveas designated doctor and clarify the issue? We want tokeep the same designated doctor.

The Appeals Panel has held that a doctor nolonger on the designated doctor list can issue aletter of clarification, but he cannot re-examine

the claimant. I would imagine the same would apply for adoctor not on the ADL.

The designated doctor list is a subset of the ADL. Youcannot be on the latter unless you are on the ADL. Youhave a problematical rule: On or after September 1, 2003,doctors who provide any functions in the Texas workers’compensation system are required to be on the ADL.180.20(a)(2). If the doctor is not on the ADL he canperform “no function.”

The argument should be that to clarify a prior opinion at atime when the designated doctor was qualified to render itis not a new function. It is supplying a missing part of theoriginal function (something like sending the supportingdocumentation that he/she failed to attach to the originalreport). After all, you are not asking for a new opinion, youare asking as to what his opinion was previously. Tointerpret the rule any other way would result in seriousabuse.

The treating doctor has billed us for medicalrecords that they copied and sent to designateddoctor at $.50 a page. Are we to pay these

charges?

Rule 133.106 arguably, but not clearly, requiresyou to pay the treating doctor in this case for themedical records sent by him to the designated

doctor. As such, we believe that there is no clear authority

requiring payment to the treating doctor for these medicalrecords. On the other hand, if presented to the TWCC ina fee dispute, this would be the rule the treating doctorwould cite in support of the carrier’s liability.

We prefer to characterize the issue as one of unbundlingand would defend a denial of the bill on that basis (whichshould be, therefore, your basis for the dispute). That is tosay, in the absence of clear authority requiring the paymentto the treating doctor for the records by the carrier, it ismerely a cost of doing business in the workers’ compensationcontext, and the treating doctor is compensated by the feesthat he charges for all of the other services he provides.This is just like mailing costs, office overhead, etc.

If, however, the bill is disputed, the doctor would have theright to request review by the Medical Review Division,and you would have to be willing to defend this veryreasonable position.

We had a fatality claim with a date of injury ofJuly 24, 1992. Claimant’s widow and her attorneysettled with the Third Parties in 1993 for a total

of $440,000.00. We are now trying to determine thefuture off set for resuming death benefits to the widow.Our Lien was $13,346.92. Please advise if the future offset for death benefits should represent the total recovery($440,000.00) minus our lien ($13,346.92) or the amountthe widow received after payment to the attorney minusour lien.

Section 417.002(a) provides that the “net amountrecovered by the claimant” is what is used toreimburse the carrier. The question turns on what

constitutes “net amount.” Some will take the position thatthis would be the amount that goes to the claimant afterreduction for attorney fees and costs. However, recently inArgonaut Insurance Co. v. Baker, 87 S.W.3d 526 (Tex.2002), the Supreme Court said: “the first money paid [to]or recovered by the employee, or his representatives,belongs to the compensation carrier paying thecompensation and until it is paid in full, the employee, orhis representatives, have no right to any funds.” (Emphasisadded). Further, § 417.003(a) provides that if the carrieris not actively represented by an attorney in a third-partyclaim, in the absence of an agreement, the court will orderan amount for attorney fees up to 1/3 of the carrier’srecovery and “a proportionate share of expenses.”Therefore, it would appear that a strong argument could bemade that the carrier’s recovery would be the entireamount recovered by the claimant, less attorney fees and


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expenses as agreed or as ordered by the court, and “aproportionate share of expenses.” Any side agreementbetween the claimant and his attorney as to additionalattorney fees should therefore have no effect on the carrier’srecovery or right to future credit. Note that this answer ismodified by HB 4, which would also offset the carrier’ssubrogation right for that proportion due to the employer’snegligence for suits filed on or after 9/1/03.

I have a file with a 0% impairment rating from thetreating doctor. A TWCC-28 was sent to theinjured worker, and she did receive it by certified

mail. I checked with the TWCC to verify that employeehas not disputed the rating. I was advised that they did nothave a copy of the treating doctor’s impairment ratingand that the 90 days does not start running until theyreceive a copy.

They are wrong. See new Rule 130.12, which isretroactive back to June 18, 2003. Ninety daysbegins the date delivery is made to the claimant by

verifiable means such as certified mail. From the preambleto the rule, it appears that this is the date sent.

When denying a medical bill based on the providernot on the ADL, what denial code or wordingshould be used?

Use code “K” on the new EOB, simply stating thatthe doctor is not on the ADL. Per the EOBinstructions, this code is: “Used when the IC is

denying payment because the HCP does not possess theappropriate Commission list status for the t/s billed anddoes not have a temporary exception to the requirement tobe on the ADL, is practicing outside HCP’s practice act,is providing t/s their licensing board has restricted, or ispracticing in violation of any sanctions or restrictionsimposed by the Commission.”

We are a TPA for a self-insured politicalsubdivision. I have a claimant that injured his hipand low back on 10/25/03. He reported the injury

on 10/27/03. Up until now, he has chosen to pay medicaltreatment out of his group health insurance and/or out ofhis own pocket. The employer was aware of the injury on10/27/03, yet did not report it to us for several monthsbecause of the claimant’s decision to pay the claimhimself. As far as denying the claim, is there any actionwe can take?

Remember that for injuries on or after 9/1/03, the60 days does not run until you, as the TPA, getnotice. So, if you are still within your 60 days you

can dispute if you have a valid basis. Remember also thatthe election of remedies doctrine does not apply to politicalsubdivisions.

I have a claimant whose treating doctor hasprescribed a motorized wheelchair. The claimantis massively obese and has never had surgery.

The claimant received a 10% impairment rating for hislower back. RME Dr agreed with the use of a motorizedwheelchair. Pre-authorization was approved on 01/07/04. DME provider has billed us, but the claimant has notreceived equipment yet. The bill was denied for procedurecodes. Reconsideration is anticipated. Peer review wasdone on 01/22/04, which provided an opinion that themotorized wheel chair is counterproductive - notreasonable and necessary. Question: Do we have to payfor the this? Do we have any grounds for dispute?

Since it was pre-authorized, you are not allowed toretrospectively dispute your URA’s determinationon the basis that it is not reasonable or necessary.

Further, even if you would otherwise have been able todispute, since the two doctors who actually have examinedthe claimant (including your RME) agree that the wheelchairis R&N, as well as the URA, it is unlikely that anyreviewing authority would be more persuaded by a peerreview.

How do social security benefits apply tosupplemental income benefits? If someone iscollecting social security may we use that as

wages?

A claimant can receive social security benefits andsupplemental income benefits at the same time.The Appeals Panel has held that “there are no

provisions under the Texas Workers’ Compensation Actof 1989 which affect compensation benefits because ofpayments from collateral sources.” Texas Workers’Compensation Commission Appeal No. 91132. Further,in AP No. 941185, the AP rejected a carrier’s argumentthat a claimant is not entitled to the “double recovery” ofSocial Security benefits and supplemental income benefitspayments. Depending on the facts of the case, an argumentmay be made that the claimant is not making a good faitheffort to return to work in light of the receipt of thesebenefits. n


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In the January issue of FOLIO it was reported that Texas Comp wasin the news. The picture portrayed in that story was of an insuranceindustry that is “brutally unresponsive.” The story related that oneproblem that was occurring statewide is that employers continue to optout of the comp system due to runaway costs.

What has not received wide-scale press is recent WCRI data asreported in the Houston Chronicle and the San Antonio BusinessJournal. The information comes from a study of 12 states, includingTexas. Other states in the study were California, Connecticut, Florida,Illinois, Indiana, Louisiana, Massachusetts, North Carolina,Pennsylvania, Tennessee and Wisconsin. These states represent about60 percent of the workers’ compensation benefits paid in the country.

The study that shows that the workers comp industry in Texascontinues to pay the highest rate in claims in states that nationallyprovide 60 percent of claims. In fact, workers compensation costs inTexas have climbed at double-digit rates for the third consecutive year.Current data shows that Texas claims cost an average of $5,320.00.The major cost driver was shown to be a 10 percent jump in medicalpayments, an 8 percent rise in wage replacement payments and a 23percent rise in benefit delivery expenses.

Utilization was also reviewed by WCRI in this study. The resultsshowed that injured workers in Texas had a greater number of doctorvisits and longer periods away from work.

According to press reports, the director of WCRI noted that“Overall, workers’ compensation costs per claim remain high in Texasand continue to rise” He added that “This report can assistpolicymakers in Texas to understand why costs are high andgrowing at a rapid pace.” n

ROC Reports NowFound at TDI Website

The Research and OversightCouncil on Workers’ Compensation(ROC) closed its operations on August31, 2003. The ROC’s researchfunctions were transferred to the TexasDepartment of Insurance by HouseBill 28 in the 3rd Called Session of the78th Legislature. ROC researchmaterials and reports are now availablefrom the Texas Department ofInsurance Web site atwww.tdi .s tate. tx.us/company/roc.html. n

TWCC Proposes/AdoptsNew Rules

The TWCC has proposed new rules andamendments to existing rules. The deadlinefor comments regarding the rule proposals isApril 14th at 5:00 p.m. Information about therule proposals can be found at the followinglink: http://www.twcc.state.tx.us/proposedrules/toc.html

The rule change proposals are related tochapters:133.308 Medical Dispute Resolution by

Independent Review Organizations133.309 Alternate Medical Necessity

Dispute Resolution by Case ReviewDoctor,

134.650 Prospective Review of Medical Carenot Requiring Pre-Authorization

134.800 Required Billing Forms andInformation

134.802 Insurance Carrier’s Submission ofMedical Bills to the Commission

As noted, these rules largely pertain tomedical benefit issues and dispute resolution.Since medical cost containment continues toremain problematic in the system, it isadvisable for carriers to closely review theserules for content regarding costs (hidden andactual,) administrative burdens and efficacy.Note article in this issue about Proposed Rule134.650. n

The TWCC has recently adopted a number of changes to rules. The ruleadoptions can be reviewed in detail at http://www.twcc.state.tx.us/rules/adopted/adopted.html and in the March 5th edition of the Texas Register.

The adopted changes to rules includes:Chapter 130Rule 130.110. Return to Work Disputes During Supplemental IncomeBenefits; Designated Doctor. (amendment)Chapter 134Rule 134.503. Reimbursement Methodology. (amendment)Rule 134.504. Pharmaceutical Expenses Incurred by the Injured Employee.(amendment)Rule 134.600. Preauthorization, Concurrent Review, and VoluntaryCertification of Health Care. (amendment)

Please contact our office if you have any questions regarding these adoptedrule changes. n

WCRI Research Shows Continuing CostIncreases in Texas Comp Industry

TWCC Adopts New Rules


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Texas Workers' Compensation CommissionQuestion/Resolution Log

This is a reprint of selected portions of an internal log utilized by the Texas Workers' Compensation Commission to memorializeinformal opinions, given by the Commission, in response to questions from the field. It is a training tool for TWCC personnel.Although these opinions are not binding, they do state current TWCC interpretations and represent Commission policy.

DateReceived

Question/Problem Resolution

HEALTH CARE PROVIDER / TECHNICALCOMPONENT / REIMBURSEMENT /TECHNICAL PORTION / MODIFIER /VIOLATION /

Is a health care provider (other than the treating,designated, or RME doctor) who does the technicalcomponent of an IR entitled to 20% of the totalreimbursement (meaning MMI, which includes level ofservice, and IR) or 20% of the body area reimbursement?When a health care provider (other than the treating,designated, or RME doctor) submits a bill for the technicalcomponent of an impairment rating to an isurance carrier,is the bill “incomplete” without the L-modifiers listed inthe 1996 Medical Fee Guideline?Is it a violation for a health care provider in this instanceto omit the L modifier from the bill?

6/ 9/0315

The health care provider (other than the treating,designated, or RME doctor) is entitled to 20% of thetotal reimbursement as outlined in the respective MFGsections governing reimbursement for treating,designated and required medical examination doctors.Section XXII(D)(1)(b) provides that “if testing isperformed by a health care provider other than thetreating doctor … reimbursement is 20% of the totalreimbursement outlined in this section”(p.14,(XXII.D.1.B.).The 20% base reimbursement does not apply to thedesignated doctor and RME, but is calculated by usingthe base rate plus the area(s) rated (MFG pages 15-16.Yes, L-modifiers are required on billing for IR testingservices in order for the bill to be considered “complete,”as defined in Rule 133.1(a)(3). If the L-modifiers are notincluded, carriers should consider the bill incompleteand take action in accordance with Rule 133.300. Notethat there is no statutory duty for health care providers tofile complete medical bills.Although a health care provider (other than the treatingdoctor, designated doctor, or RME) should use a modifierindicating the level of service, it is not a violation for ahealth care provider to omit the L-modifier from the bill.

DESIGNATED DOCTOR / TREATING DOCTOR/ ELIGIBILITY / RULE 130.5(d) / RULE180.21(k)(11) /

Rule 130.5(d) says a treating doctor can become thedesignated doctor if they have not treated the injuredemployee within the last 12 months for the condition to beevaluated. Is there a time that the designated doctor canbecome the treating doctor for the specific injury evaluated?Specifically, the injured employee sends a letter ofclarification and the designated doctor wants to re-examinethe injured employee. A new 32 is required to be filedwith a matrix to make sure the doctor is still qualified tobe the designated doctor. If he is not qualified to do theexam the commission is required to select the next doctoron the list that is qualified. Can the doctor that is nolonger qualified to be the designated doctor then becomea treating doctor for this injury?What happens to presumptive weight for the disqualifeddoctor?

The Act and Rules do not include any provision whichallow a designated doctor, including those no longerqualified, to become the treating doctor for the specificinjury evaluated. Rule 180.21(k)(11) provides sanctionsfor a designated doctor who becomes the treating doctorfor the injury evaluated as the designated doctor.If the original designated doctors response to the letter ofclarification is the need to re-examine the injured employeeand he has become disqualified for the examination, anew doctor must be selected to examine the employee andaddress the questions raised. Since the new doctor mustcomplete a new examination to properly respond to theletter of claification, the new doctor’s report would beafforded presumptive weight

8/14/0316


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FLAHIVE, OGDEN & LATSON DIRECTORY

KEY TASK DIRECTORY

Allain Collins 435-2170 867-1715 APC Sharon Youso 435-2233

Bobby Stokes 435-2150 867-1705 RDS Anita Drake 435-2249

Carlos Acosta 435-2177 867-1712 CA1 Sally Stephens 435-2242

Chuck Finch 435-2158 867-1713 CCF Ryan Wimble 435-2264

Dana Gannon 435-2151 867-1710 DMG Margo Davis 435-2263

Greg Solcher 435-2175 867-1718 GDS Sally Stephens 435-2242

Jack Latson 435-2156 867-1724 JWL Patsy Shelton 435-2234

James Sheffield 435-2169 867-1703 JRS Sharissa Karol 435-2224

Katie Flahive 435-2168 867-1702 KMF Gina Mitschke 435-2229

Kevin MacEwan 435-2166 867-1706 KEM Cynthia Sherman 435-2274

Lynette Phillips 435-2165 867-1708 LLP Karen VanLoo 435-2240

Nancy Ippolito 435-2181 867-1735 NHI Anita Drake 435-2249

Pamela Peavy 435-2163 867-1736 PEP Rita Paul 435-2250

Paul Stone 435-2157 867-1716 PBS Bronna Sanders 435-2269

Paul Warren 435-2159 867-1719 PDW Kiran Hashmi 435-2225

Rebecca Strandwitz 435-2160 867-1720 RMS Bronna Sanders 435-2269

Rhett Robinson 435-2154 867-1709 SRR Marilyn Mueller 435-2236

Rob Dollars 435-2164 867-1707 RAD Karen VanLoo 435-2240

Ron Johnson 435-2178 867-1722 RMJ Ryan Wimble 435-2264

Roy Leatherberry 435-2179 867-1714 RJL Andrea Tuttle 435-2238

Scott Bouton 435-2153 867-1737 SDB Marilyn Mueller 435-2236

Steve Tipton 435-2162 867-1704 SMT1 Mary Casebier 435-2275

Susan Veltman 435-2152 867-1717 SRV Sharon Durr 435-2230

Tom Wilkins 435-2183 867-1727 TRW Gina Mitschke 435-2229

Tricia Blackshear 435-2180 867-1723 PHB Lisa Black 435-2260

Attorneys Direct Dial(512)

Direct Fax*(512)

E-Mail **[email protected]

Paralegal Paralegal(512)

*Attorney's direct dial fax no. is directed to his/her paralegal.** Alternative e-mail address: first initial+last [email protected] (Example: [email protected])

Admin. Violations Dianne Townsend 435-2289 867-1724 DLT

BRC Settings (FO&L - Req. For Evid.) Cindi Friedel 435-2244 477-4987 CAF

Disputed Claims (TWCC-21) Tillie Aguirre 435-2235 477-4996* TAA

General Questions Receptionist 477-4405 867-1700 GQS

Insurance Coverage (TWCC-20) Phyllis Devine 435-2267 867-1748 PAD

Med Review Disputes Annette Moffett 435-2266 867-1733 AMM

Records Request/Photostats Phyllis Devine 435-2267 867-1748 PAD

Request for BRC (TWCC-45) Tillie Aguirre 435-2235 477-4996 TAA

Designated Doctor Filings Brandi Senters 435-2251 479-5319 BES

TWCC Manual Sales Joel Ogden 435-2256 472-9160 JMO

*#2 TWCC-21 fax # Tillie Aguirre 435-2235 472-4935* TAA

Task Direct Dial(512)

Direct Fax(512)

[email protected]

ContactPerson


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Interest CalculatorFirst Quarter

4.76%

12

3

4

5

"X" Value Weeks "X" Value Weeks "Y" Value Weeks "Y" Value0.0014 27 0.3456 1 0.0009 27 0.02470.0032 28 0.3711 2 0.0018 28 0.02560.0060 29 0.3976 3 0.0027 29 0.02650.0096 30 0.4250 4 0.0037 30 0.02750.0142 31 0.4533 5 0.0046 31 0.02840.0197 32 0.4825 6 0.0055 32 0.02930.0261 33 0.5126 7 0.0064 33 0.03020.0334 34 0.5437 8 0.0073 34 0.03110.0416 35 0.5756 9 0.0082 35 0.03200.0507 36 0.6085 10 0.0092 36 0.03300.0607 37 0.6423 11 0.0101 37 0.03390.0717 38 0.6769 12 0.0110 38 0.03480.0836 39 0.7125 13 0.0119 39 0.03570.0964 40 0.7491 14 0.0128 40 0.03660.1100 41 0.7865 15 0.0137 41 0.03750.1247 42 0.8248 16 0.0146 42 0.03840.1402 43 0.8641 17 0.0156 43 0.03940.1566 44 0.9042 18 0.0165 44 0.04030.1739 45 0.9453 19 0.0174 45 0.04120.1922 46 0.9873 20 0.0183 46 0.04210.2114 47 1.0302 21 0.0192 47 0.04300.2315 48 1.0740 22 0.0201 48 0.04390.2525 49 1.1188 23 0.0211 49 0.04490.2744 50 1.1644 24 0.0220 50 0.04580.2972 51 1.2110 25 0.0229 51 0.04670.3209 52 1.2584 26 0.0238 52 0.0476

NOTE: For partial weeks, round up to next week (8 2/7ths weeks = 9 weeks).

Determine number of weeks of continuous payment owed. Find corresponding “X” value on chart.

TIBs: Calculate interest from the 7th day after first day benefits began, or the 7th day after the first notice, whichever is LATER.

Calculate interest from the 5th day after notice of the certification of MMI and impairment, or the date of a CARRIER dispute of MMI or impairment, whichever is EARLIER.

IIBs:

Interest Rate Effective from 1/1/2004 through 3/31/2004:

Determine total benefits plus interest owed by adding interest from steps 2 and 4, and adding total benefits to be paid.

Multiply “Y” by the total benefits owed (not including interest determined in steps 1 and 2 above). This is the approximate amount of interest owed from benefit ending date to payment date.

Determine number of weeks between ending date of payments and date benefits are to be paid. Find corresponding “Y” value on chart.

Multiply “X” by weekly compensation rate. This is the approximate amount of interest owed on the ending date of benefits.

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1920

5

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Weeks1

Accumulated Interest from Beginning to End of Continuous Payment

Accumulated Interest from End of Payment Period to Date Paid


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APPEALS PANEL DECISIONS

Texas Workers' Compensation Commission Appeal No. 032661A decision from a Contested Case Hearing at which the issue of disability was considered would precludeany further consideration of the issue of disability for the period extending up to the date of that ContestedCase Hearing.

Facts: An initial Contested Case Hearing took place on April 19, 2002 at which the issue of disabilitywas considered. The Hearing Officer determined that the claimant had disability from September 10, 2001through March 11, 2003. That decision was reversed by the Appeals Panel and the case was remanded backto the Hearing Officer to consider the issue of compensability. At a second hearing taking place on September3, 2002, the Hearing Officer determined that the claimant had a compensable injury resulting in disability fromSeptember 10, 2001 until March 11, 2002. That decision was affirmed by the Appeals Panel. Yet anotherContested Case Hearing occurred on September 9, 2003. That hearing resulted in a finding of disability fromMarch 12, 2002 through September 9, 2003. The carrier appealed this determination contending that the issueof the claimant’s disability from March 12, 2002 through September 3, 2002 had previously been litigated,and the decision in that case was res judicata on that issue.

Holding: The Appeals Panel agreed with the carrier. The Hearing Officer’s decision concerningdisability through September 3, 2002 was reversed and rendered. The Appeals Panel affirmed the HearingOfficer’s decision on the issue of disability for the period from September 4, 2002 to the date of the ContestedCase Hearing, September 9, 2003.

Texas Workers' Compensation Commission Appeal No. 032612The Hearing Officer incorrectly found a 12% impairment rating based upon the opinion of the designateddoctor, where the designated doctor’s impairment rating was based upon findings resulting from anexamination taking place prior to the eventual applicable MMI date.

Facts: The designated doctor originally certified that the claimant reached MMI on March 14, 2002with an impairment rating of 10%. The claimant subsequently underwent cervical surgery on January 28,2003. The surgery consisted of a cervical discectomy and fusion. A letter of clarification was sent to thedesignated doctor providing medical records concerning the cervical surgery and inquiring as to whether ornot those records necessitated a change in his previous findings. The designated doctor declined to changehis previous findings in response to this letter.

A second letter of clarification was sent to the designated doctor. In response to that letter thedesignated doctor indicated that he felt the DRO was pushing him to assign additional impairment based uponwhat he considered to be an unnecessary operation. He did increase the impairment rating based upon theoccurrence of the surgery to 12%. He declined to change his previous MMI date.

The Hearing Officer following a Contested Case Hearing determined that the claimant reached MMIon March 20, 2003 (the statutory MMI date). The Hearing Officer found that the impairment rating was 12%as found by the designated doctor. The carrier appealed contending that the designated doctor’s MMI dateof March 14, 2002 was not overcome by the great weight of the other medical evidence. The claimant appealedthe impairment rating finding.

Holding: The Appeals Panel affirms the Hearing Officer’s finding that the statutory MMI datewas controlling. The Appeals Panel reverses the Hearing Officer’s determination that the impairment ratingwas 12% and remands with instructions to seek a further evaluation by the designated doctor. The Appeals


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CASE DECISIONSTEXAS COURT OF APPEALS

Panel points out that the designated doctor did not reexamine the claimant, after the claimant had surgery inJanuary of 2003. The 12% impairment rating was based upon findings resulting from an examination that tookplace prior to the claimant’s surgery and prior to the controlling MMI date found by the Hearing Officer. Animpairment rating assigned prior to the MMI date is invalid. Accordingly the Appeals Panel remands to theHearing Officer with instructions to have the claimant reexamined by the designated doctor and require thedesignated doctor to provide a new report concerning the impairment rating.

Texas Workers' Compensation Commission Appeal No. 032608The Hearing Officer erred in excluding the carrier’s “Cert-21” based upon the lack of a timely exchangeof that document, where one of the issues to be considered at the Contested Case Hearing was whether ornot the carrier had timely disputed compensability.

Facts: A Contested Case Hearing was held to consider the issue of whether or not the carrier hadwaived the right to dispute compensability. The Hearing Officer excluded the carrier’s offer of a “Cert-21”based upon the lack of timely exchange of that document. The Hearing Officer ultimately concluded that thecarrier waived the right to dispute the compensability of the claim. The carrier appealed.

Holding: Reversed and remanded. Section 410.163(b) provides that a Hearing Officer shallinsure the preservation of the rights of the parties and the full development of facts required for thedeterminations to be made. Based upon this provision the Appeals Panel holds that the Hearing Officer erredin excluding the carrier’s Cert-21. That document was crucial to the Hearing Officer’s determination as towhether or not the carrier had waived the right to dispute compensability. The Appeals Panel reverses theHearing Officer’s decision finding waiver and remands the case to the Hearing Officer with instructions toadmit and consider and the Cert-21 in reaching his decision.

Etie v Walsh & Albert Company, Ltd. (Tex. App - Houston [1st Dist])Facts: Clark Construction Group, Inc., contracted with Enron to build Enron Building #2. Clark

subcontracted part of the work to Way Engineering Company, Inc. Clark exercised an option in its contractwith Way Engineering to buy a single workers’ compensation insurance policy from Travelers Property &Casualty Group to cover all subcontractors & employees who worked at the Enron Building #2 site. WayEngineering, in turn, entered into a lower tier subcontract with Walsh & Albert, Ltd., to perform the sheetmetal work on the building. Walsh & Albert & its employees were also covered by the workers’ compensationinsurance. P was employed by Way Engineering & was injured when a plenum improperly attached to theceiling by a Walsh & Albert employee fell & struck him. P sought & recovered workers’ compensation benefits& filed a 3rd party negligence suit against Walsh & Albert. Both Walsh & Albert entities filed motions forsummary judgment, which the trial court granted.

Holding: Affirmed. The statutory employer/employee status given to general contractors whoexercise an option to provide workers’ compensation insurance in contracts with subcontractors includes allemployees of all subcontractors, regardless of the tier they occupy, & all of the covered workers at the siteshould be considered “fellow servants” who enjoy full immunity from suit.


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Senate Select CommitteeContinued from p. 1

DDR ProcessContinued from p. 1

sophisticated extent of injury dispute involving potentiallyhundreds of thousands of dollars will be determinedupon the opinion of the chiropractor randomly appointedby TWCC.

This proposal by TWCC is not in effect. TWCC isaccepting public comments on the rule until 5:00 onApril 14, 2004. This is a very significant and troublesomechange in the way these issues are resolved. If you wishto comment, you should definitely do so by submittingyour comment to [email protected]. Thisis especially important if you are an employer, inasmuchas you are represented on the Commission by threecommissioners. For further information about thisproposal, contact Jack Latson at 512-435-2156. n

public hearing: “the cost of doing this will outweigh anysavings we have.”

Dr. William Nemeth, the medical advisor to theTexas Workers’ Compensation Commission expressedcaution on the subject of quickly establishing networks.Because nine out of ten networks fail, the TWCCcommittee charged with studying the network conceptwanted to insure that enough information was in placefor it to be successful. Dr. Nemeth indicated that TWCCwas four to six months away from requesting an RFP.

The problem with the House Bill 2600 networkconcept is that there are few incentives for healthcareproviders to participate. Dr. Nemeth anticipated $1,000in costs to the hospitals to become involved in thenetwork and pointed out that Colorado attempted thesame concept and that their network costs $37 million toestablish.

A great deal of thought has been put into theinfrastructure and it appears, that for it to work, it wouldbe very complicated. That in turn will take time, and itdoes not appear to be a feasible solution prior to theSunset Review process in 2005.

John Nash, a former TWCC Commissioner, and alabor representative from Chandler, Texas testified,along with a claimant attorney and another unionrepresentative. All three supported the HNAC andbelieved that any alternative was better than the currentsystem. They, of course, blamed Texas insurancecarriers for the high cost of medical treatment in Texas(and, by implication, probably blame Texas drivers forthe high cost of gasoline).

The committee also received testimony from SORM,Texas A&M, University of Texas, and other state riskmanagers regarding their particular experience in theworkers’ compensation system. n

consequences, because, according to a temporary nurseworking at Vista, the staff did not “know how to doCPR”). Inspectors have also been troubled by failure tomaintain records of nursing accreditation, theunavailability of doctors for follow up care of surgicaland other admitted patients, refusal to accept patients(mostly small children), and refusal to perform evenperfunctory evaluations in stabilizing treatment asrequired by law, etc.

In lawsuits filed by patients and their families, theplaintiffs’ allege that Vista provided unnecessarytreatments and surgery, that equipment did not work,and staff either ignored patient complaints or madeserious mistakes (one patient claims that his doctoroperated on the wrong knee, then operated on the otherknee the same day).

Vista is only one of two hospitals in the Houston areathat is not accredited by the JCAHO, which accreditshospitals in the US. More than 80% of hospitals areaccredited. n

Vista Medical CenterContinued from p. 2

HCP ComplianceTWCC has monitored the number of TWCC-69s that

were filed timely with the Commission. Although thosenumbers have trended upwards, as of 2003, the providercompliance was at 69%. In 1998, providers were filing 47%of bills timely.

Carriers, on the other hand, on average, are payingmedical bills within twenty days. Excluding requests forreconsiderations, this amounts to a processing date that is lessthan half of the 45-day requirement.


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Healing a Bad BackContinued from p. 4

Many in each group continued to feel some painbut were living with it. "Many continue to have grumblingsymptoms and occasional flare-ups," Dr. Deyo said."Their pain was better but certainly not gone."

Since no one knows the cause of most back pain,Dr. Hadler said, imaging is not much help. Nor are mosttreatments. "Maybe you're better off not going to adoctor," he said.

Dr. Deyo concurs what while a small proportionof patients may be helped by surgery, medical care maynot be necessary for most.

Surgery, too, is under new scrutiny, with anational study getting started at 11 medical centers.About 1,000 patients with the problems that most oftenlead to surgery will be randomly assigned to havesurgery or not. The problems under the study are herniateddisks, spinal stenosis, which is a narrowing of the spinalcanal that usually occurs with arthritis and aging, anddegenerative spondylolisthesis, a slipped vertebra.

One of the investigators in the study is Dr. JamesN. Weinstein, a Dartmouth professor of orthopedics andcommunity and family medicine and the editor in chiefof Spine, the professional journal that published theDuke report in its January issue.

"I've met with two groups who said they fear theresults will take away their practice," Dr. Weinstein said."I don't know how to deal with that. I don't know what theresults will be."

Back experts say it is clear that surgery canmake some patients feel better immediately.

"Let's say you have a herniated disk and let's sayyou have leg pain and let's say you are as miserable ashell and you convince somebody to operate on you, " saidDr. Michael Modic, chairman of the radiology departmentat the Cleveland Clinic. "You have a 95 percent chanceof waking up with no pain."

Most people will get better anyway, Dr. Modicsaid, but surgery can "reduce the symptomatic timeperiod."

Dr. Thomas Errico, president of the NorthAmerican Spine Society, says surgery is a last resort. Hispatients have x-rays or M.R.I.'s. They are told to stretchand to get their weight under control. They might get asteroid injected into the spine to reduce inflammation.

"That's what the vast majority of the 3.700

members of the North American Spine Society do," Dr.Errico said. "The vast majority discourage surgery ordon't offer surgery as the first recourse."

Whether patients benefit from treatment orwhether their pain eases on its own, back experts agreethat 10 percent of cases are intractable. Dr. RowlandHazard, a professor of orthopedics and medicine atDartmouth, estimates that 80 percent to 90 percent ofspending on back pain "is devoted to this 10 percent whodon't get well."

Their prognosis is disheartening. Those withdisabling pain for three or four months have just a 10percent to 20 percent chance of getting better in the nextyear.

For this group, some doctors are now advocatinga different approach altogether: teaching people to livewith pain, to put aside the understandable fear that anymotion will aggravate their injury. They have to learn,Dr. Weinstein said, that "Hurt doesn't mean harm."

In programs often known as functionalrestoration, that is a the goal. Patients are trained instrength, flexibility and endurance. They are counseledabout their fears of re-injury and about anxiety anddepression.

It can be difficult to get them back to work, notedDr. Bigos, of the University of Washington, becausemany left their jobs on disability and had bitter disputeswith their former employers or with insurance companies."Usually, lines have been drawn in the sand by one orboth sides," he said.

But success is possible, said Dr. Thomas Mayer,director of a clinic called Pride, for ProductiveRehabilitation Institute of Dallas for Ergonomics. Amongthe 3,500 back patients who entered his one- and two-month program and completed it, almost all returned towork and nearly half went back to their original employer,Dr. Mayer said.

"We deal with the face on," Dr. Mayer said."What are you going to do for the rest of your life? Whatare you getting from being disabled? What would youget if you were not disabled?"

The lesson, Dr. Weinstein says, is that "you canhave pain and still function." And while there mayappear to be more treatments than ever, he adds, "moreisn't necessarily better." n

Flahive, Ogden & LatsonP.O. Box 13367Austin, Texas 78711

FO&L Fax DirectoryTo help expedite your faxed information to the correct area within FO&L and get it to the responsible person at the earliest time, usethe following fax directory. Please remember the 3:30 p.m. receipt deadline for material required to be date stamped at theCommission. Material received after 4:00 p.m. does not permit time to deliver it across town prior to the Commission close.

Note: TWCC numbers are bolded.


FOLFOLFOL

Fax Number Attention To: Subject Matter:

(512) 477-4996 Tillie Aguirre Notice of Refusal (TWCC-21) or BRC Requests (TWCC-45)(512) 472-4935

(512)867-1748 Phyllis Devine Insurance Coverage (TWCC-20)Record ChecksPhotostats

(512) 867-1733 Annette Moffett Medical Review Disputes (TWCC-60)SOAH/Medical Review

(512) 867-1701 Patsy Shelton Advisory InformationExtra Hazardous Employer

(512) 867-1724 Dianne Townsend Compliance & Practices

(512) 479- 5319 Brandi Senters Designated Doctor Filings (TWCC-32)Suspension of TIBs (TWCC-34)

(512) 477-4987 Cindi Friedel BRC & PHC HearingsRFEs, Set Notices, Hearings,Files, Cancellations

(512) 867-1700 Paralegals All CCH-Related Info.

(512) 867-1700 FOL All materials not listed above

(512) 472-9160 Joel Ogden TWC Manual Orders & Information

folio -1-folio. furthermore, if you have a last minute deadline, call our office by 3:00 p.m. and...

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