Fort Worth city staff are looking to remove or lessen hurdles in the workers’ compensation process for first responders.
An April 7 presentation from city human resources employees came a couple months after issues with Fort Worth’s workers’ compensation system came to light.
Along with informing council members, first responders and the general public about the complexities of workers’ compensation, human resources director Kristen Smith said her department is dedicated to helping city employees navigate the complicated process.
“It doesn’t matter if we have one claim or thousands of claims; every claim is specific to that employee,” Smith said. “They only care about the care that they are receiving and how they’re navigating their claims. That is the approach that I and my team are committed to focusing on.”
Workers’ compensation difficulties for Fort Worth first responders have come under media scrutiny in the last couple of months. Firefighter Caleb Halvorson, police officer Bobbie Sanchez and others have shared stories surrounding delay of care or claim denials.
Council member Charlie Lauersdorf said at the public safety committee that over 30 first responders have contacted him detailing their own difficult stories navigating the system.
“When we say, ‘We want to provide quick care with dignity and respect,’ that’s not happening,” Lauersdorf said to the Fort Worth Report. “Nothing has been quick. And it’s not just onesies and twosies. It’s a systemic issue that we’re finding, but no one’s really talking about it.”
A recent investigation by the Fort Worth Star-Telegram found that 341 claims from Fort Worth first responders were denied over the last two years.
The shift is a recent one, said Skyler Ainesworth, vice president of the Fort Worth Professional Firefighters Association. In a presentation to city officials, he noted in the last two years, dialogue between staff and firefighter representatives around claim appeals has not been productive.
“It’s why doctors don’t want to join the network. If you join the network, you would think your treatment plan would be approved, but we deny our own doctors’ treatment plan,” Ainesworth said.
Several months ago, Lauersdorf was one of the first city officials to speak publicly on the issue, “declaring war” on Sedgwick, the company that manages workers’ compensation claims for the city of Fort Worth.
Ainesworth said the issue is not with Sedgwick — the company’s primary role is to save money.
He noted, however, that the city has full authority to overturn claim denials from Sedgwick. City staff have consistently refused to do so in the last two years, he said.
“The city of Fort Worth can do the right thing by the employee, and we’ve advocated for them to make these changes,” Ainesworth said to the Report. “And the stance has been that they’re not going to overturn denials.”
Since first responder stories have been shared publicly, city staff have approved several workers’ claim appeals, Ainesworth said.
“You’ve got to wonder why,” he said. “What made them change their mind and start suddenly doing what we believe is the right thing for the employees while they’re injured? I’ve got to assume it’s public pressure.”
Ainesworth also said approval of surgeries has taken longer over the last two years. Those delays, he said, add additional costs for the city.
Systemic changes
City Manager Jay Chapa told council members in January that a search had already begun to employ an additional case manager specifically to support first responders throughout the workers’ compensation process.
Smith confirmed to council members that the recruitment for two senior analysts for police officers and firefighters is already underway.
Lauersdorf said the new staff was a good start, but “absolutely not enough.”
“I’m glad we’re starting somewhere, but especially whenever you have 700 cases (a year) for first responders, two is certainly not gonna be enough,” he told the Report.
In her presentation, Smith highlighted several aspects of the complexity surrounding workers’ compensation.
Smith noted there is currently no waiver process for city employees to seek care with a specialist out of network. Danielle Caster, the city’s workers’ compensation manager, said the city will create a one-time single case agreement with a provider if they agree to certain workers’ compensation rates.
The city generally prefers for employees to seek out-of-network care if there is a need, Smith said.
“We like for these changes to originate from a medical condition that we cannot meet within network,” she added.
Smith also noted a desire to properly educate first responders around the workers’ compensation process.
“If I am injured today, today is when I should understand what is next for me,” Smith said.
Council member Elizabeth Beck lauded the plan to add case managers for first responders, but cautioned against wholesale changes to any current or future agreement with third party claims administrators.
She noted the history of the workers’ compensation space in Texas has shifted several times. Workers and employers alike have previously taken advantage of the system, Beck said.
“We have a responsibility to our first responders and our general employees,” Beck added. “We also have a fiduciary responsibility to our taxpayers, which is why we engage with organizations like Sedgwick.”
A new competitive bidding process for workers’ comp coverage will begin this year, Smith said, with implementation beginning in fiscal year 2027.
She told council members to expect two to three applications.
A step in the right direction
Halvorson, who attended the public safety committee meeting, said he’s glad sharing his story publicly earlier this year brought the conversation around workers’ compensation to light.
He conceded that it was unfortunate it took public statements against the process to make systemic changes, but that it was important for him to speak up.
“Unfortunately, with the fire service, there’s guys that get injured or killed every day, and I just want the best care for them and their families,” Halvorson said.
The Fort Worth firefighter thinks the city can make several changes to the current process — he notes that first responders and regular city staff may need to be on different workers’ compensation plans because of the nature of the work.
In general, Halvorson thinks the process needs to be more flexible.
“I believe that they’ll make this right, not just for me but for the next people, the next men and women that continue to serve this city,” Halvorson said.
Ismael M. Belkoura is the health reporter for the Fort Worth Report. His position is supported by a grant from Texas Health Resources. Contact him at ismael.belkoura@fortworthreport.org.
At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.
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