Workers Compensation Underpayment

In recent months, CampbellWilson has uncovered an underpayment issue with a Texas Certified Workers' Compensation Health Care Network ("Certified Network"). The underpayment is resulting from a dormant clause in the contract that became active a few years after execution. A review of the Texas Worker's Compensation regulations was conducted and it has been determined that the calculation methodology employed by the Certified Network is contrary to regulatory mandates, thus inappropriate.

To provide an illustration of the impact of the clause, we offer the following case. Our client executed a contract with the Certified Network in 2004. Included in the contract where multiple year network contract rates (e.g. fee schedules, case rates, etc). However; and unbeknownst to the client, in 2006, a clause kicked in that converted the negotiated contract rates to a payment methodology that was neither negotiated nor disclosed during the initial contract formation, and as mentioned above, contrary to Texas Worker's Comp mandates. For the year reviewed, we estimate the underpayment to be in excess of $850,000 (includes statutory interest). Presently, we are actively negotiating with representatives from the Certified Network on behalf of a single client and anticipate resolution of this matter in the near future.

If you are currently contracted for the provision of Texas Worker's Compensation services, we encourage you to contact us for a courtesy review of your contracts (and claims, if necessary) to determine if you have been subjected to the underpayment. Please note, any action for recoupment of an underpayment is subject to the applicable Statute of Limitations, thus time is of the essence.

For additional information please contact Manie Campbell, Pat McCaa or Todd Prine at (214) 373-7077.

15770 North Dallas Parkway, Suite 500, Dallas, TX 75248 | 214.373.7077 | Toll Free: 800.723.6492