Texas Mutual’s Commitment to Fighting Fraud

You may have seen articles or news stories recently concerning Texas Mutual’s efforts to prosecute health care companies, physicians, claimants and employers who commit workers’ comp fraud. Workers’ compensation fraud is a crime that affects everyone and adds unnecessary costs and friction to the system, which is paid for by all employers in the form of higher premium. Texas Mutual is dedicated to controlling workers’ compensation costs for Texas employers, and that’s something we’re proud of.

However, these articles presented false information, including the notion that we are unreasonably harsh in our prosecution of fraud. This is not true.

Texas Mutual and the District Attorney’s office

In reality, Texas Mutual’s relationship with the Travis County District Attorney’s office was authorized statutorily many years ago to help keep workers’ compensation fraud in Texas to a minimum. This funding agreement with the DA only allows for the company to refer criminal cases to the DA for review, not for us to have any influence on what happens to those cases after they’re referred. The District Attorney maintains complete and independent discretion to prosecute these cases. Additionally, those whom the DA chooses to prosecute for committing fraud are still entitled to all the rights and remedies of the judicial system, including trial by jury. Texas Mutual’s relationship with the DA’s office starts and ends with submitting cases for them to investigate.

Pursuing fraud

Our fraud program is fair and industry leading. In fact, the Texas Legislature requires that Texas Mutual maintain an anti-fraud program. As a policyholder-owned insurance company, we must do what is in the best interest of the 62,000 Texas business owners we cover, and that means following up when fraud is suspected or reported to us. Doing so benefits our policyholders, agents and the workers’ compensation system as a whole.

The articles suggest that claimants are disproportionately targeted for prosecution. All it takes to see that this is false is a look at the number of cases we refer to the DA’s office. For example, we received 47,900 workers’ compensation claims in 2014 and referred only 13 cases of claimant fraud to the DA that year. This ratio is consistent over the years – only a tiny fraction of claims are ever referred to the DA for prosecution. The vast majority of fraud dollars recovered come from organized health care and premium fraud cases.

Workers’ compensation fraud is something we take seriously because of the commitment we make to our policyholder owners to be good financial stewards, and we’re proud of that. We stand by the successful fraud prevention program that we have developed and will continue to pursue those who try to commit fraud. Some people talk about fighting fraud, but at Texas Mutual, we do it.

One Response to Texas Mutual’s Commitment to Fighting Fraud

  1. Bob Rookie says:

    I do not think the average policyholder has anything to worry about from Texas Mutual’s anti-fraud efforts. If you read the cases, it takes an intentional act of fraud to be prosecuted, not some simple mistake filling out a form. These are intentional acts of fraud being prosecuted to keep premiums lower for every policyholder.


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