How bad are the problems in Texas current workers' compensation system? Let me begin to answer this question by quoting headlines from two recent Texas newspaper editorials on the topic. "Mess in workers' comp calls for reform efforts," declared the San Antonio Express-News, while the Beaumont Enterprise concluded there was a "dire need to change" our current system.


The Express-News provided some alarming statistics to make their case, noting "the costs for each injured worker are 38 percent higher than in comparable states and doctor visits per claim are 64 percent higher."


Meanwhile, the premium costs are so high that almost 40 percent of Texas employers have dropped their coverage.


Business groups, organized labor representatives, and doctors agree that there are big problems with what we have in place now. The Texas Association of Business notes that Texas is ranked dead last in its ability to get injured workers back on the job. The Texas AFL-CIO concluded it "has failed miserably to serve the needs of workers, employers, and doctors." As for physician dissatisfaction, a survey of by the Texas Medical Association revealed that only 23 percent of their members would take on new workers' comp cases.


The Texas Legislature is in solid agreement that the time is ripe for fixing workers' compensation. This is a topic that has been studied extensively over the interim by committees in both chambers and we are ready to get to work.


What might the fix look like? The Texas Sunset Advisory Committee, a policy group comprised of members of both legislative chambers and private citizens, reviewed the Texas Workers Compensation Commission (TWCC) over the interim and recently approved a set recommendations that would, if approved during the upcoming session, result in a complete restructuring of the current program.


Here is a brief overview of what the Sunset Advisory Commission suggests. First up, they propose the transfer of all regulatory function involving the workers' compensation system to the Texas Department of Insurance and moving any education functions to the Texas Workforce Commission. Once accomplished, the TWCC should be abolished and an Office of Employee Assistance created in its place.


The State of Texas should then require worker's compensation to operate as close as possible to the Group Health Insurance regulations that cover other standard health insurance programs.


The Sunset Advisory Commission suggested that Texas' revamped workers' comp system should seek to look like the network services provided under group health insurance. This would include requirements that all medical treatments and services be ordered by a primary care provider. There would be limits placed upon retrospective reviews of medical necessity and the prompt payment procedures that now apply to group health plans would cover workers' compensation.


Group health insurance carriers would also to be allowed to offer workers' comp policies as a product.


The Sunset Advisory Commission also urged that the cap on injured workers' income benefits be increased from 100 percent of the State Average Weekly Wage to 130 percent of it. The current 28 day waiting period requirement to receive payments of the first week of benefits would be reduced to 14 days.


There should also be requirements for skilled case managers as early as practical for assisting with lost time disability cases.


As I mentioned earlier, there are committees in both chambers now looking at how to fix this broken system and the final legislative product may vary significantly from the Sunset Advisory Committee recommendations.


What is certain, however, is that injured employees are the ones being hurt the most by the failures of Texas' current system of workers compensation. While the expense of the current system is unacceptably high when measured in dollars, it also far too costly in lost human potential.