Agency Administration
Agency Administration consists of Office Administration, Customer Service, Document Processing and Agency Outreach and Training. The Office Administration section processes all
procurement requests, agency travel arrangements and subsequent reimbursement
for travel expenses, oversees the agencys fixed assets, and coordinates
all telecommunications and building maintenance requests. All human resource
functions reside with Office Administration, including personnel actions
and leave accounting. The Document Management section is responsible for
the initial setup and data entry of injury claims received, as well as the
maintenance of all inactive claim files. The director of Agency Administration
serves as the agency's Customer Service Liaison and Records Retention
Officer.
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Agency Outreach and Training provides health and safety, risk management,
and workers' compensation claims coordinator training for state agencies.
This section also assembles and maintains technical online documents and manuals,
such as the "Claims Coordinator Handbook", and produces the quarterly SORM newsletter, Risk-Tex.
Claims Operations
The Claims Operations Division is divided into claims units, a Customer Service Call Center, a Quality Assurance Unit and a Medical Cost Containment Unit. Client agencies are assigned to specified claims units.
Upon receipt of the file, Claims Operations performs the initial investigation of each reported injury and determines compensability. Claims Operations follows all claims until their conclusion to ensure that each state worker receives the medical and income benefits due under the Texas Workers' Compensation Act.
The Medical Cost Containment Unit within Claims Operations is comprised of the Medical Provider Assistance, Case Management, Medical Audit and Disability Management teams.
Fund Accounting
Fund Accounting processes and issues approved workers' compensation medical and indemnity payments to claimants and medical providers, including the cancellation, re-issue, and correction of warrants. This division also administers the assessment program which allocates the amounts to participating state agencies for the costs of operating the agency, including processing workers' compensation claims. Fund Accounting provides all accounting and budget functions for the agency in coordination with the Office of Attorney General (OAG) Accounting and Budget Divisions.
General Counsel
General Counsel provides legal and policy assistance for agency-wide issues,
as well as decisions that affect covered state agencies. This division consists
of several sections, including Governmental Relations, whose primary duty
is maintaining SORM's relationship with other governmental entities. Dispute
Resolution is responsible for the central coordination of SORM's participation in the Texas Department of Insurance, Division of Workers' Compensation Benefit Review Conferences.
The Subrogation unit is responsible for the recovery of workers' compensation
benefits, medical costs, and other expenses paid on behalf of state employees
injured in the course and scope of employment due to the negligence of a
third party. Investigations gathers information about workers' compensation
injuries to assist claims adjusters.
Information Resources
SORM Information Resources division provides various reports either periodically or as needed to state agencies to aid them in determining the frequency and severity of claims and losses, and to begin establishing historical trend information to help determine projections of minimum and maximum probable losses. RMIS (Risk Management Information System), an interactive internet based website, allows agencies to create basic reports directly, and to report agency and claims information directly. The Division also provides desktop computer support and support for SORM divisions for the various other systems used:
- Claims Management System (CMS) – An internally developed software that provides claims management and the accounting business functions;
- Risk Management Information System (RMIS) – An internally developed software that provides state agencies with end user functionality for reporting to both the Risk Assessment and Loss Prevention and Claims Divisions;
- Filenet – Customized software that stores and indexes scanned claims documents.
Risk Assessment and Loss Prevention
The Risk Assessment and Loss Prevention (RALP) section provides risk management, insurance, and loss control services to State Office of Risk Management (SORM) client agencies. Risk Management Specialists conduct on-site consultations to assist state agencies in establishing and maintaining risk management programs to protect state employees, state assets, and the public served by SORM client agencies. Risk management program reviews are also performed to determine the status of state agency efforts to develop and implement comprehensive risk management programs. RALP risk management specialists assist SORM client agencies with agency risk management issues or concerns by conducting agency requested on-site consultations at the agency. The section develops and provides risk management guidelines, model risk management manuals, programs, and procedures for use by state agencies. The Risk Assessment and Loss Prevention section also assists state agencies with accident/incident reviews and analysis.
RALP also performs the duties outlined in HB 1203, 77th Legislature, which authorized SORM to operate as an insurance manager for SORM client agencies, including a requirement that SORM's board phase in, by line of insurance, the requirement that a state agency purchase insurance coverage only through SORM, if a statewide program has been implemented for that line of insurance. SORM established administrative rules at 28 T.A.C. 252.301 implementing the program, including application and reporting requirements. Insurance specialists perform specialized reviews on all submitted and renewed insurance proposals for coverages, limits, insurer financial stability, loss controls, necessity, and appropriateness. Insurance specialists assist agencies throughout the entire procurement process by providing exposure analysis, assisting with application completion, and if needed, providing program presentations to agency executive management. Claims management assistance is provided for all lines of insurance coverage. Insurance specialists also provide insurance expertise and assistance to state agencies on insurance requirements for vendors/contractors. SORM also has oversight responsibilities involving fidelity and notary bonds.
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