State of Denial

WFAA-TV’s 19-part series State of Denial details questionable practices by state agencies and major insurance companies involved with the Texas workers compensation system. In this long running investigation, which began in 2003, reporter Brett Shipp, investigative producer/executive producer Mark Smith, executive producer for special projects Nann Goplerun, and editor/photographer Kraig Kirchem found state regulators lost sight of their assigned role: “Ensure appropriate and efficient health care for all injured employees.” The series detailed possible fraud and potentially unethical practices by a number of major insurance companies, activities ignored or unpunished by regulators. Several companies reportedly mailed “stripped” medical records, files lacking information important for the approval of worker claims, to their hired peer review doctors. The series also reported that state regulators slashed fees to participating doctors by up to 50 percent. Yet, insurance carriers denied benefits and medical treatment to the injured by almost 50 percent compared to the previous year. In 2003, these strategies enabled workers’ compensation carriers to take in nearly $1 billion more in premiums than benefits paid out. Since the series began, Texas Workers’ Compensation Commission Chairman, Richard Smith, resigned, and Executive Director Richard Reynolds retired. A state panel recommended that the Texas Workers’ Compensation Commission be abolished and a special office set up to ensure injured workers be provided swift, adequate care. For an eye-opening look into improprieties in the Texas Workers Compensation Commission, a Peabody Award goes to State of Denial.