TAN Team Tracks New Law to Allow Texas Mutual in Group Health Market

TAN Team Tracks New Law to Allow Texas Mutual in Group Health Market
Interim Hearing Takes Up Texas Mutual’s New Health Insurance Authority

The Texas Legislature won’t be in session until January, but its committees are already at work. Recently, the Texas Alliance of Nonsubscribers’ governmental affairs team reported on an interim hearing conducted by the House Insurance Committee. Among the topics considered was HB 3752, the 2021 bill that authorized workers’ compensation insurance giant Texas Mutual Insurance Company (TMIC) to write group health insurance coverage in the state. The Legislature expanded TMIC’s authority to provide the coverage in hopes of developing low-cost alternatives to existing group health insurance plans.

HB 3752 required TMIC to submit a report to the Legislature no later than Sept. 1, 2022, informing the Legislature on whether it intends to write group health insurance and, if so, how such coverage would comply with all considerations and guiding principles identified by the Legislature under the new law, which is codified at Section 2054.601 et seq. of the Texas Insurance Code.

TMIC’s representative testified at the hearing that the company has not yet determined whether it will offer health insurance benefits, acknowledging that writing health insurance is significantly different than offering workers’ compensation coverage, and that expansion into the health insurance arena would be a challenge for the company.

In response to concerns expressed by the organization’s members, TAN’s government relations team proposed an amendment during the legislative session to clarify TMIC’s ability to compete in the nonsubscriber marketThe amendment stated:

(c)   A subsidiary of the company [i.e., TMIC] may not offer or issue an occupational policy for an employer or an employer’s employees covering an occupational bodily injury, disease, or death that explicitly provides liability coverage to an employer that elects not to maintain workers’ compensation insurance coverage under Chapter 406, Labor Code.

TAN’s amendment was acceptable both to legislators and to TMIC, and was included in the version of HB 3752 that was adopted. The organization will continue to monitor any legislative and regulatory developments related to the new law and welcomes input and suggestions from members on additional steps that may be taken.

Checking the Numbers: 2022 Midterms on Track to Maintain Status Quo in Texas

The 2022 election is just a few months away, and it seems like déjà vu all over again. Texans haven’t elected a Democrat to statewide office since Bob Bullock won his second term as lieutenant governor in 1994. Persistent predictions over the past two decades that demographic changes would soon turn Texas “purple” have failed to materialize. The takeaway: Republicans will continue to dominate Texas ballot boxes in the November 2022 election. 

And yet, while observers expect little change in overall Republican control of the state’s legislative machinery, one race suddenly seems surprisingly tight. According to the latest University of Texas/Texas Politics Project poll, conducted by Jim Henson and Joshua Blank, incumbent Gov. Greg Abbott leads Democratic challenger Beto O’Rourke by only 6 points among registered voters, 45% to 39%, with 3% choosing third-party candidates and 13% either someone else or remain undecided.

General Election: November 8, 2022
Early Voting: October 24 – November 4

The UT/TPP poll surveyed 1,200 Texas voters representative of the demographic characteristics of the state’s population. It was conducted from June 16-24, 2022, and is the 50th in a series of public polls initiated in 2008 as part of the Texas Politics Project at UT Austin. Significantly, a poll taken around the same time by the University of Houston’s Hobby School of Public Affairs shows similar numbers. It has Abbott leading O’Rourke 49% to 44% among likely voters, with 5% undecided and 2% supporting the Libertarian candidate, Mark Tippetts. And recently released fundraising numbers show O’Rourke raising some $27.6 million to Abbott’s $24.9 million for the period ending June 30, 2022 — a record haul for O’Rourke and a figure Newsweek called “troubling” for Abbott.

While the governor’s race is raising eyebrows among political observers, other statewide contests are more predictable. In a rematch of the 2018 race for lieutenant governor, for example, the UT/TPP poll indicates that incumbent Republican Dan Patrick leads Democratic challenger Mike Collier 38% to 26%, with 11% preferring Libertarian Shanna Steel and 31% either “someone else” or remaining undecided. Despite some legal troubles of his own, incumbent Attorney General Ken Paxton leads Democratic challenger Rochelle Garza 37% to 29%. And in a “generic” congressional ballot, Republicans lead Democrats 46% to 41%, while in the generic ballot for Texas Legislature, Republicans also lead Democrats 46% to 41%.

There are few, if any, close Texas House or Senate races. While the House’s legislative district maps are the subject of current litigation, they will likely stay in place for the 2022 election. The maps are drawn in such a way as to minimize competitive inter-party contests; rather, they tend to favor the incumbents of either party. Republicans currently hold a significant advantage in seats in both the House (84-65, with one vacancy) and Senate (18-13), and the districts are expected to return roughly equal proportions of representation in the 2022 election.

While the 2022 election seems highly likely to return a crop of legislators in similar proportions as in the past, the governor’s race bears watching. Widespread voter dissatisfaction has so far not focused on the office at the top of the ballot, but that could change. The aftermath of the Uvalde shooting, the reversal of Roe v. Wade, and general unhappiness with the economy could combine to make the governor’s race closer than in the past.

Poll Sheds Light on Key Election Year Issues in Texas

The latest University of Texas/Texas Politics Project survey conducted by Jim Henson and Joshua Blank provides a snapshot of current attitudes on several key issues that are expected to influence voters as the November election nears.

The survey found Texans expressing overwhelmingly negative views of the economy:

  • 53% said that their personal economic situation is worse than a year ago;
  • 58% said the Texas economy is worse than a year ago; and
  • 73% said the national economy is worse than it was a year ago.

All three results represented the highest negative assessments since the poll began tracking these attitudes.

With elections for statewide offices and the Texas Legislature just over four months away, 59% said the state was on the wrong track — the largest share of negative responses in the poll’s history.

Texans’ widespread negative economic assessments were likely influenced by the impact of rising prices. Asked about the impact of price increases on their household’s current financial situation:

  • 68% reported that increases in the cost of gas were having a major impact.
  • 59% said the same of increases in the cost of food.

In response to another question, inflation, gas prices or the economy were cited as the most important problem facing the country by 41% of poll respondents.

Majorities of Texans expressed support for gun control measures in similar magnitudes to polling conducted prior to Uvalde:

  • 78% supported expanded background checks on all gun purchases in the United States, including at gun shows and during private sales, while 16% opposed such changes.

When asked about allowing courts “to require a person determined to be a risk to themselves or others to temporarily surrender guns in their possession,” commonly called a “red flag law,” 66% expressed support, while 24% were opposed. Such laws are in effect in the District of Columbia and 19 states, including Florida, but not Texas.

The UT poll was taken just before the United States Supreme Court announced its decision in the Dobbs case, which overturned Roe v. Wade and thereby eliminated a 49-year constitutional right to early-term abortion access. Though taken slightly too early, however, the poll found that only 37% of Texans support the Texas “trigger law” designed to take effect after repeal of Roe v. Wade. While some observers have predicted the Dobbs decision might lead to backlash against Republicans at the polls nationally, it’s unclear what effect, if any, such sentiments will have in Texas.

To view the complete poll summary, click here.

TDI-DWC Report Highlights Costs of Hospital Services in State WC System

The average cost of workers’ compensation claims in Texas involving hospital/institutional stays increased 38% from 2016 through 2020, according to a report from the Texas Department of Insurance, Division of Workers’ Compensation, Workers’ Compensation Research & Evaluation Group.

Large increases were seen in 2018 and 2020, with the average cost per claim at six months post-injury increasing 19% from 2017 to 2018 and 12% from 2019 to 2020. The average cost per claim at 12 months post-injury also increased 19% from 2017 to 2018 and 12% from 2019 to 2020.

The findings are among several in a report from the research group that examined workers’ compensation claims with hospital services between Jan. 1, 2016, and Dec. 31, 2020.

For purposes of the report, hospital/institutional services include inpatient services, outpatient services, and other services such as those provided by skilled nursing facilities, home health care, intermediate care, clinic or hospital-based end-stage renal disease (ESRD) facilities, special facility, or hospital surgeries. Data used come from hospital/institutional billing and payment data insurance carriers report to DWC.

According to the report, the number of claims receiving hospital/institutional services was stable from 2016 to 2019, but decreased by 26% in 2020. In each injury year, more than 95% of these hospital claims had outpatient services, but only 5% had inpatient services.

Total hospital cost increased from $294 million in 2016 to $334 million in 2018, but decreased to $262 million in 2020.

The average hospital cost per claim increased in 2018 and 2020. In 2018, the average cost per claim for inpatient services increased due to the increases in average cost per service and average number of paid services per claim. In 2020, the large increase in average number of paid services per claim led to an increase in average cost per claim for inpatient services, even though the average cost per service decreased.

The report is available here.

Report Highlights Workers’ First-Year Injuries

An examination of more than 1.5 million workers’ compensation claims across multiple industries nationwide shows 35% of workplace injuries happen to workers hired within the past year, regardless of age or industry experience. These first-year injuries resulted in more than 6 million missed workdays, representing 37% of all missed workdays caused by injury.

The findings are included in the 2022 Injury Impact Report compiled by Travelers, the largest workers’ compensation carrier in the United States. The report documented 1.5 million workers’ compensation claims filed between 2015 and 2019. According to the report, the most common causes of first-year injuries were overexertion (27%); slips, trips and falls (22%); struck by object (14%); cuts and punctures (6%); caught-in or -between hazards (6%); and motor vehicle accidents (6%).

The most common injuries of first-year employees were:

  • Strains and sprains — 38%
  • Fractures — 13%
  • Contusions — 9%
  • Cuts and puncture wounds — 6%
  • Inflammation — 6%
  • Dislocations — 6%

Industries most affected by first-year injuries:

  • Restaurants — 53% of claims and 47% of claim costs.
  • Construction — 48% of claims and 52% of claim costs.
  • Services — 43% of claims and 38% of claim costs.
  • Transportation — 39% of claims and 41% of claim costs.

The data show that even experienced employees are at a higher risk of an injury during their first year of employment. They can be new to the role, new to the department, or recently returning to work in a transitional duty role after an injury.

After the first year on the job, employees are still at risk of injuries at work. Sprains and strains top the list for longer-tenured workers, according to Travelers’ data. Regular safety training can ensure that employees understand and adhere to safety expectations and procedures.

Being Prepared for an Active Shooter

Unfortunately, no amount of preparation can fully protect an organization from an active shooter, but recent mass shootings have focused attention on steps organizations can take to prepare for an active shooter situation on-site.

According to the U.S. Department of Homeland Security, the most effective way to train staff for an active shooter situation is conducting mock active shooter training exercises. Local law enforcement is an excellent resource in designing training exercises.

Additional advice from DHS includes ensuring the facility has at least two evacuation routes, with evacuation routes posted in conspicuous locations throughout the facility.

Human resources departments and facility managers should plan for emergency situations, including an active shooter scenario. DHS advises HR’s responsibilities include:

  • Conducting effective employee screening and background checks.
  • Creating a system for reporting signs of potentially violent behavior.
  • Making counseling services available to employees.
  • Developing an EAP that includes policies and procedures for dealing with an active shooter situation, as well as after-action planning.

The facility manager’s responsibilities should include:

  • Instituting access controls (e.g., keys, security system pass codes).
  • Distributing critical items to appropriate managers/employees, including floor plans, keys, facility personnel lists, and telephone numbers.
  • Coordinating with the facility’s security department to ensure the physical security of the location.
  • Placing removable floor plans near entrances and exits for emergency responders.
  • Activating the emergency notification system when an emergency occurs.

An active shooter may be a current or former employee, or an acquaintance of a current or former employee. Employees typically do not just “snap,” but display indicators of potentially violent behavior over time. Potentially violent behaviors by an employee may include:

  • Increased use of alcohol and/or illegal drugs.
  • Noticeable decrease in attention to appearance and hygiene.
  • Depression/withdrawal.
  • Resistance and overreaction to changes in policy and procedures.
  • Repeated violations of company policies.
  • Increased severe mood swings.
  • Noticeably unstable, emotional responses.
  • Explosive outbursts of anger or rage without provocation.
  • Suicidal; comments about “putting things in order.”
  • Increasingly talks of problems at home.
  • Talk of previous incidents of violence.
  • Empathy with individuals committing violence.
  • Increase in unsolicited comments about firearms, other dangerous weapons, and violent crimes.

Workers Say More Mental Health Support Will Help Them Stay in Job

Another fresh survey finds most full-time U.S. workers find their job is too stressful and are burned out. And despite record resignation rates in 2021, a third of those surveyed say they are considering quitting.

The Talkspace Stress Survey 2022 polled 1,400 full-time employees in the United States between March 31 and April 8. It found that nearly 60% of workers would stay at their job if it offered more mental health services. The survey findings show there are ways employers can protect employees’ mental health.

Some 86 percent of employees who report their managers take steps to protect their mental health are more likely to find their work fulfilling. Fifty-eight percent of employees who say their manager does not support their mental health report higher levels of burnout. Fifty-two percent of employees who say they lack manager support for their mental health report higher levels or workplace stress. Managers who model good behavior can set expectations about healthy work-life balance. Additionally, limiting after-hours communications helps employees adopt healthy behaviors.

Workers surveyed say additional mental health services, or simply extra paid time off, would go a long way. Fifty-seven percent of all workers say they would likely stay at a job if it offered more mental health services. Among workers who say they want to quit, 66% would stay if the job offered more mental health services. Almost 3 in 4 workers (74%) say more paid time off, like mental health days, would make them consider staying at their jobs.

Determine whether your employees are using all their vacation days or PTO, and set an example, as managers, that these days are critical to your own work-life balance.

Report Highlights States’ Approaches to Reimbursement for Medical Marijuana for Work Injuries

As more states legalize recreational and medical marijuana, no consensus has emerged for whether workers’ compensation insurers are required to reimburse, allowed to reimburse, or are prohibited from reimbursing an employee for medical marijuana use to treat a work-related injury or illness.

A recent report from the National Council on Compensation Insurance shows states taking different approaches to the question in 2022:

  • Mississippi, Rhode Island and South Dakota enacted legislation, and other states including Kentucky, Maine and Nebraska introduced legislation, providing that workers’ compensation insurers are not required to reimburse for medical marijuana.
  • New Jersey and New York are considering legislation that requires workers’ compensation coverage for medical marijuana under certain circumstances.
  • State courts continue to rule on this issue as well. Most recently, state supreme courts in New Hampshire and New Jersey ruled that reimbursement is allowed, while the states’ highest courts in Massachusetts and Minnesota ruled that reimbursement is not required.
  • The U.S. Supreme Court in its most recent term declined to hear an appeal of two Minnesota Supreme Court decisions that held reimbursement is not required.

Recreational marijuana is illegal in Texas. Low-dose tetrahydrocannabinols (THC) cannabis is allowed under the state’s Compassionate Use Program for patients with epilepsy, seizure disorders, multiple sclerosis, spasticity, amyotrophic lateral sclerosis, autism, terminal cancer, or an incurable neurodegenerative disease.


United State Department of Labor
OSHA Extends National Emphasis Program to Protect High-risk Workers from Coronavirus 
The U.S. Department of Labor’s Occupational Safety and Health Administration is extending its Revised National Emphasis Program for COVID-19 until further notice. The program focuses enforcement efforts on companies that put the largest number of workers at serious risk of contracting the coronavirus, and on employers who engage in retaliation against workers who complain about unsafe or unhealthful conditions or exercise other rights under the Occupational Safety and Health Act. Click here for full article.

Joint Effects of Socioeconomic Position, Race/Ethnicity, and Gender on COVID-19 Mortality among Working-Age Adults in the United States
Substantial racial/ethnic and gender disparities in COVID-19 mortality have been previously documented. However, few studies have investigated the impact of individual socioeconomic position (SEP) on these disparities. Click here for full article.

Hartford HealthCare
A New Study Says Omicron Is Less Likely to Cause Long COVID. But Does the Science Hold Up?
Smartphone apps are designed to make just about everything more convenient – and recently, that includes a study about long COVID. Click here for full article.

The Guardian
Wrist-worn Trackers can Detect COVID Before Symptoms, Study Finds
Health trackers worn on the wrist could be used to spot Covid-19 days before any symptoms appear, according to researchers. Click here for full article.

COVID-19: U.S. Impact on Antimicrobial Resistance
As an infectious disease physician, I have a frontline understanding of antimicrobial resistance—when germs like bacteria and fungi defeat the drugs designed to kill them. Antimicrobial resistance was one of our greatest public health concerns prior to the COVID-19 pandemic, and it remains so. Click here for full article.

World Economic Forum
Workplace Well-being: Stress Increasing Since COVID-19 Began
Workers around the world are feeling stressed and disengaged, according to a report that finds workplace well-being and satisfaction have plateaued after almost a decade of improvements. Click here for full article.

U.S. Department of Labor
US Department of Labor, CDC, US Surgeon General Seek Public Input in National Online Dialogue on Long COVID’s Workplace Challenges
In an effort to better understand long COVID-19 in U.S. workplaces, the U.S. Department of Labor, the Centers for Disease Control and Prevention and the U.S. Surgeon General are inviting the public to join a national online dialogue beginning today to gather ideas to better support workers coping with symptoms, their co-workers and their employers. Click here for full article.

ABC News
Experts Reveal how Likely Reinfection is From COVID with Spread of Omicron Subvariant BA.5
Early in the COVID-19 pandemic, the prevailing theory was that if someone was infected with the virus, they were immune — at least for a while. Click here for full article.

Bloomberg Law
Workplace Covid Testing Must Be ‘Business Necessity,’ EEOC Says
Employers should now take more factors into consideration when choosing whether to screen employees for Covid-19, according to new guidance from the EEOC. Click here for full article.

Business Insurance
California Workers Comp COVID Claims Nearly Triple in May
The California Workers’ Compensation Institute on Wednesday reported that the number of claims for COVID-19 nearly tripled in May. Click here for full article.

Florida Politics
State Data: Nearly 5K COVID-19 Workers’ Comp Claims Filed in 2020 Remain Open
Nearly 5,000 people who filed COVID-19-related workers’ compensation claims in 2020 have cases that still remain open, according to the latest available state data. Click here for full article.

Texas News

Austin Monitor
Workers Defense Asks for Construction Standards on Statesman PUD
In anticipation of one of Austin’s next big construction projects, advocacy group Workers Defense Project demanded Tuesday morning that the redevelopment of the former Austin American-Statesman site at 305 S. Congress Ave. lead to safe and well-compensated construction jobs as well as on-site affordable housing. Click here for full article. 

State News

The Oklahoman
Judge Appoints Herself in Last-ditch Effort to Provide Oversight to Okla. Workers’ Comp Cases
In a last-ditch move to ensure thousands of injured workers can have their day in court, a workers’ compensation judge appointed herself to continue hearing cases after the Oklahoma Legislature failed to extend her position. Click here for full article. 

Yellowstone Actress Q’orianka Kilcher Charged with Workers’ Compensation Insurance Fraud 
Q’orianka Kilcher has been charged with two felony counts of workers’ compensation insurance fraud in California. Click here for full article.

Insurance Journal
Report: California Workers’ Comp Written Premium Down in 2021
Written premium for 2021 was 1.4% below that for 2020 and is the lowest since 2012, a new report shows. Click here for full article.

California Private Self-Insured Claim Frequency Hit a 14-Year High in 2021
Workers’ compensation claim frequency among California’s private self-insured employers hit the highest level since 2007 last year as both medical-only and indemnity claim volume rose according to a California Workers’ Compensation Institute (CWCI) review of initial data from the state Office of Self-Insurance Plans (OSIP). Click here for full article.

Workers’ Comp Benefits Owed to Widow After Husband Fatally Injured While Driving to Educational Program
On April 1, 2022, the Michigan Supreme Court issued its opinion in Lewis v. LexaMar Corp., 971 N.W.2d 608 (Mich. 2022). This reversed a December 17, 2020 decision from the Court of Appeals, which we previously wrote about in this blog. Click here for full article.

Investigate Midwest
Her Foot was Crushed on the Job. When She Asked to be Compensated for Lost Wages, ‘They Said No.’
In 2019, at a vegetable packing warehouse in western Michigan, a forklift crushed Maria’s right foot. Click here for full article.

The Center Square
Missouri Supreme Court Gives Public Employees Rights When Terminated Over Workers’ Compensation Cases
Missouri school districts and other political subdivisions no longer are immune to workers’ compensation retaliation claims, after a school custodian who failed a drug test won his case. Click here for full article.

Puerto Rico Enacts New Legislation on Remote Workers of “Out-of-State” Employers
On June 30, 2022, the governor of Puerto Rico signed into law Act No. 52 (Act 52-2022), which amended the concept of “engaged in trade or business” under the Puerto Rico Internal Revenue Code of 2011, to address the pandemic-related issue of employees working remotely from the Island for “out-of-state” employers with no business nexus to Puerto Rico. Click here for full article.

Commercial Appeal
7 Takeaways From our Investigation of Tennessee’s Workers’ Compensation System
The Commercial Appeal spent months speaking with injured workers and reviewing hundreds of documents related to workers’ compensation cases in Tennessee. Click here for full article.

Office of the West Virginia Governor
Gov. Justice: Workers Compensation Insurance Rates Drop for 18th Straight Year, More Good News for West Virginia Businesses
Gov. Jim Justice announced today that the National Council on Compensation Insurance (NCCI), West Virginia’s rating and statistical agent, has filed a proposed workers’ compensation loss cost decrease of 7.2%, effective Nov. 1, 2022. Click here for full article.

Insurance Journal
Wisconsin Insurance Premiums for Worker’s Comp Decline
Wisconsin companies will pay 8.47% less in worker’s compensation insurance rates starting Oct. 1, the Wisconsin Department of Workforce Development reported. Click here for full article.

Industry News

EHS Daily Advisor
The Other Side of Safety: Workers’ Compensation
There is more to safety and health than dealing with Occupational Safety and Health Administration (OSHA) inspections, citations, and penalties. Workers’ compensation is the other side of it. Workers’ compensation claims are much more common than OSHA inspections. Click here for full article. 

Insurance Business America
Challenges in the Workers’ Comp Space
The workers’ compensation space is facing new challenges as claims costs rise. So what’s the outlook for the industry? Click here for full article.

Insurance Business America
Do Workers’ Compensation Benefits Cover Mental Health-related Claims?
Mental illness continues to be an issue plaguing the country’s adult population, affecting the daily lives of nearly one in five (19.9%) Americans, the latest figures from Mental Health America (MHA) reveal. The number, according to the non-profit’s 2022 Prevalence Data, is equivalent to almost 50 million US adults, up from about 47 million in the previous year. Click here for full article.

JD Supra
Medical Marijuana, Workers’ Compensation, and the CSA: Hazy Outlook for Employers As States Wrestle With Cannabis Reimbursement as a Reasonable Medical Expense
While each state has its own unique workers’ compensation program, workers’ compensation generally requires employers to reimburse the reasonable medical expenses of employees who are injured at work. Depending on the injury, these expenses can include hospital visits, follow-up appointments, physical therapy, surgeries, and medication, among other medical care. Click here for full article.

Confidence in Workers Compensation
The US workers compensation system is strong, resilient, and healthy and it’s currently the best-performing line of property-casualty insurance. Click here for full article.

Post Register
It’s the Law: Workers’ Compensation During Travel
My company was recently asked to send some employees a few hours away for an overnight job where my staff would be driving back in the wee hours of the morning. My office manager suggested the company purchase energy drinks to help the crew stay awake on their return. As the company owner, am I exposing myself to liability by providing stimulants like these? Click here for full article.

Combating Medical Fraud in Workers’ Compensation Claims
Workers’ compensation is a “no-fault” insurance system that was established to provide benefits (medical care and lost wage benefits) to employees injured or who suffer illness or disease while in the course and scope of their employment. Click here for full article