Insurance Daily News

Texas study shows lower costs, faster recovery in workers comp network

A new report from the Texas Department of Insurance compares outcomes for injured workers treated inside the state’s certified workers‑compensation health networks with those treated elsewhere. Over the two‑year period from June 1 2023 to May 31 2025, the analysis covered 219,941 network claims and 216,371 non‑network claims. Average medical expenses six months after injury were $2,941 for network patients versus $3,297 for non‑network patients, an 11 % reduction. For lost‑time claims, costs fell to $7,409 within networks compared with $8,901 outside them.

The study also highlights faster access to care and quicker return to work. Network patients waited an average of 3.9 days for initial non‑emergency treatment, while non‑network patients waited 5.1 days. Eighty‑nine percent of network claimants had returned to work at some point, versus 81 % of those outside the networks, and they missed an average of eight weeks of work compared with 14 weeks for non‑network workers. Satisfaction surveys of 2,161 injured workers showed 63 % of network participants were satisfied with their care, against 59 % for non‑network patients.

The findings suggest that the 22 certified networks covering all 254 Texas counties may deliver both cost efficiencies and better health outcomes. Network patients were more likely to receive professional medical and pharmacy services, whereas non‑network patients relied more on hospital services. These patterns could inform future policy decisions on network certification and employer participation.

Why it matters

The results indicate that Texas workers‑compensation networks can lower costs and improve recovery, influencing employers, insurers, and policymakers.

FAQ

What time frame does the report cover?
The report examined claims for injuries occurring between June 1 2023 and May 31 2025.

How many workers were included in the network and non‑network groups?
The analysis included 219,941 injured workers treated within networks and 216,371 treated outside networks.

What was the average medical cost difference for lost‑time claims?
Average medical costs were $7,409 for network claims and $8,901 for non‑network claims.

How did return‑to‑work times compare between groups?
Network patients missed an average of eight weeks of work, while non‑network patients missed 14 weeks.

Source: Business Insurance. See the original source for full details.