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Fort Worth officials, firefighters press for changes after spike in workers' compensation denials
Summary
City HR Director Kristen Smith outlined the workers' compensation program and the city's reliance on a third-party administrator; firefighters and multiple council members said denials and delays have risen recently and urged stronger internal oversight and network expansion.
Kristen Smith, the city's human resources director, told the Fort Worth Public Safety Committee on April 7 that the city averages roughly 1,500'1,700 workers' compensation claims a year and participates in the Texas workers' compensation framework overseen by the Texas Department of Insurance. She described the city's network of providers, nurse case managers and a third-party administrator, Sedgwick, that manages claims and reporting.
The presentation prompted sharp questions and testimony from first responders, who said the city has seen a recent spike in denials and lengthy delays for surgeries. Firefighter Skyler Ainsworth told the committee the change corresponds to staffing and administrative shifts since 2024 and argued that the TPA's cost-saving stance has reduced constructive dialogue with treating physicians: "Their business model exists to save money," Ainsworth said, adding that surgeries recommended by treating specialists have been denied in favor of less invasive options.
Council members pressed city staff for operational fixes and more accountability. Council Member Flores asked about dedicated case managers; Smith said the city is recruiting two senior HR analysts who will act as care coordinators for police and fire in addition to nurse case managers. Assistant City Attorney Stephen Comeby clarified that "council can decide to accept a claim" and direct the city to cover treatment even if a TPA initially denies it, and that such coverage would be handled through the workers' compensation scheme.
The committee also discussed practical steps to reduce denials and delays: expanding the in-network provider base, pursuing local partnerships with major medical centers, improving internal escalation lines so employees do not have to contact elected officials for urgent approvals, and expanding nurse case management and independent employee feedback surveys. Kristen Smith said the city will go to competitive bidding for TPAs this calendar year with implementation planned in FY27.
Several speakers urged the committee to track outcomes and appeals. The chair requested a staff information report on the number of surgery and treatment denials and what percentage were overturned on appeal, using Sedgwick data and prior-provider historical records. The committee also asked for a related information report on officer-involved pursuit injuries and city costs over the past 12 to 24 months.
The committee did not take a formal policy vote on workers' compensation reforms at the meeting; members described the discussion as the beginning of a longer review and requested additional staff analysis and data.
