This course provides a comprehensive overview of the concepts specific to Texas Workers’ Compensation claims, including what constitutes a compensable injury, liability defenses, deadlines, the different types of income benefits, and the administrative dispute resolution process.
It covers the concepts affecting the provision of medical benefits in Texas Workers’ Compensation claims, including medical dispute resolution and in-network v. out-of-network care. Learning Objectives
By taking this course, you will learn the ins and outs of how insurance companies operate in Texas. The course is delivered via self-paced, online modules and an end-of-course exam, as described below.
- Texas Workers’ Compensation Insurance System Overview
This module covers the technical aspects of insurance in Texas including how insurance underwriters determine the premium employers pay and what factors drive up the cost of a workers’ compensation insurance policy.
- Introduction to Texas Workers’ Compensation/Compensability & Liability Issues
This module covers the basic but unique definitions applicable to Texas workers’ compensation claims. You will first become familiar with the agency that regulates the administration of workers’ compensation in Texas – the Texas Department of Insurance, Division of Workers’ Compensation. You will then learn what constitutes a compensable injury in Texas, with regard to both specific and occupational injuries, as well as the statutory and other defenses to liability. Plus, you will be apprised of the various reporting and dispute deadlines, and how cases are affected if they are not met.
- Income Benefit Issues, Part 1
This module covers the definition of average weekly wage - the starting point for all income benefits - and the three types of income benefits most commonly paid: Temporary Income Benefits, Impairment Income Benefits and Supplemental Income Benefits. You will learn how the calculation of average weekly wage can vary, depending on the type and duration of employment, and what non-pecuniary wages are included. You will also learn the calculation, dispute and duration of each category of income benefit.
- Income Benefit Issues, Part 2/Income Benefit Dispute Resolution
In this module, you will learn the specifics of the two remaining types of income benefits: lifetime income benefits and death benefits. You will be able to define the types of injuries that qualify for lifetime income benefits, calculate the amount of benefits owed and determine when such benefits accrue. You will also be able to identify the hierarchy of beneficiaries for death benefit purposes. Then, we will move to the income benefit dispute resolution process, where you will come to understand the various levels of this administrative process, as well as the use of agreements and settlements in the Texas Workers’ Compensation process.
- Medical Benefits, Networks and Medical Dispute Resolution
This module covers the various issues relevant to the delivery of medical benefits in the Texas Workers’ Compensation system. You will learn what types of treatment and services can be provided, and by whom, as well as which ones require pre-authorization. You will become aware of the use and applicability of treatment, disability guidelines and medical fee guidelines.
You will also learn about the use of health care networks within the Texas system, and the rules applicable to such treatment. Then, we will move on to the medical dispute resolution process, during which you will become familiar with the different types of reviews for medical necessity and fee disputes.
- Trends in Texas Workers’ Compensation
This live or recorded Webinar provides updated information on new Texas Supreme Court cases, DWC Appeals Panel Decisions and legislative changes.
One exam included in the Texas Workers' Compensation Series. It consists of 50 questions with a 90 minute time period. You must first take the Texas Workers' Compensation Series training modules before taking this exam. You will have one attempt to pass this exam. The pass mark is 75%.
You will receive six months of unlimited access to this package. Upon placing your order, you will receive an email with instructions to access your online training. You may begin immediately!Note: This course may be taken independently for professional development or in conjunction with other courses to earn the Workers Compensation Specialist (WCS) designation. Click on the hyperlinked item for a full description of the designation.