September 16, 2026 at 5:30 PM – Employee Benefits, Insurance and Risk Management Committee Meeting

In the next episode of As The World Turns the Brownsville Independent School District seeks answers to the vexing question of who’s on first, what’s on second…….

Agenda
I. Employee Benefits, Insurance and Risk Management Committee Meeting Called to Order
II. Pledge of the Allegiance/s
III. Roll Call:
IV. Review of Third Party Administrators Insurance Providers
V. Independent Review Scope – Employee Benefits Department & Self-Funded Health Plan Governance
V.A. Objective:
V.A.1. Assess whether the district’s Employee Benefits Department decision-making process is independent, data-driven, and free of undisclosed conflicts of interest, given the district’s direct financial exposure as a self-funded plan sponsor.
V.B. Scope Areas:
V.B.1. Meeting Governance
V.B.1.a. Attendance logs and minutes for Employee Benefits Department meetings (prior 12–24 months)
V.B.1.b. Identification of all non-district personnel present (brokers, TPA/carrier reps, consultants) and their stated role/authorization
V.B.1.c. Review against any existing district policy on vendor participation in internal deliberations
V.B.2. Conflict of Interest
V.B.2.a. Disclosure records for any district staff, board members, or committee participants with financial ties to current or prospective vendors/carriers
V.B.2.b. Cross-check of participant affiliations (e.g., agency/carrier employment) against district conflict-of-interest policy and, if applicable, Texas Local Government Code Ch. 176 (conflict disclosure requirements for local government officers)
V.B.3. Vendor/Carrier Relationship History
V.B.3.a. Timeline of TPA and carrier selection/renewal decisions, and the stated rationale (RFP results, cost comparisons, board minutes)
V.B.3.b. Whether carrier changes or retention decisions correlate with cost/quality data or with the presence of specific individuals in the decision process
V.B.4. Financial Performance of the Self-Funded Plan
V.B.4.a. Claims experience, loss ratio, and stop-loss performance over the review period
V.B.4.b. Trend in employee premium contributions relative to plan cost drivers
V.B.4.c. Comparison of current TPA/carrier fees and service levels against market benchmarks
V.B.5. Network/Access Decisions
V.B.5.a. Documentation supporting any proposed or executed changes to provider network access (e.g., facility or service-area changes)
V.B.5.b. Employee utilization data supporting or contradicting the stated rationale for those changes
V.C. Methodology:
V.C.1. Document request and review (minutes, contracts, disclosure forms, claims/financial reports)
V.C.2. Confidential staff interviews, conducted by the reviewer without department leadership present
V.C.3. Benchmarking against comparable self-funded district plans in the region
V.D. Deliverables:
V.D.1. Written findings report with specific factual observations (not recommendations on personnel)
V.D.2. Recommended policy language for vendor participation in internal meetings
V.D.3. Recommended conflict-of-interest disclosure process going forward
V.E. Independence Requirement:
V.E.1. Reviewer should have no current or prior contractual relationship with any carrier, TPA, or broker involved in the districts plan
V.F. Presentation of our current, Workers Compensation contracted services, status and claims pending
VI. Workers’ Compensation Program Presentation – TRISTAR Risk Management, Third-Party Administrator and Loss Control Provider Request a formal presentation by TRISTAR Risk Management regarding the District’s Workers’ Compensation Program, including claims administration, loss experience, loss control activities, safety training, and claims investigation practices. The purpose of this presentation is to provide the Board with a clear assessment of the District’s workers’ compensation loss experience, the effectiveness of TRISTAR’s claims administration and loss control services, the extent of safety training being provided to District departments, and the procedures being utilized to appropriately investigate claims and reduce preventable injuries and questionable workers’ compensation claims.
VI.A. Workers’ Compensation Loss Runs Provide actual and complete workers’ compensation loss runs for the past three years, including the current 2026 year-to-date period.
VI.A.1. The loss runs should clearly identify, at minimum:
VI.A.1.a. Total number of claims by year.
VI.A.1.b. Open claims.
VI.A.1.c. Closed claims.
VI.A.1.d. Amount paid on each claim.
VI.A.1.e. Current outstanding reserves on each open claim.
VI.A.1.f. Total incurred amount for each claim.
VI.A.1.g. Aggregate paid losses by year.
VI.A.1.h. Aggregate outstanding reserves by year.
VI.A.1.i. Aggregate total incurred losses by year.
VI.A.1.j. Claims that have been denied.
VI.A.1.k. Claim status and disposition.
VI.A.1.l. Department/work location associated with each claim, when available.
VI.A.1.m. Type and nature of injury.
VI.A.1.n. Date of injury.The presentation should specifically identify the number and percentage of workers’ compensation claims denied during each of the past three years, including 2026 year to date, and these figures should reconcile with the loss runs provided.
VI.B. Loss Control and Safety InspectionsTRISTAR should provide a report detailing its loss control activities for the District for the past two years, including the current 2026 year-to-date period.
VI.B.1. The report should include:
VI.B.1.a. Number of safety inspections performed each year.
VI.B.1.b. Departments and facilities inspected.
VI.B.1.c. Dates inspections were conducted.
VI.B.1.d. Safety hazards or deficiencies identified.
VI.B.1.e. Corrective recommendations made.
VI.B.1.f. Follow-up inspections or verification that corrective actions were completed.
VI.B.1.g. Outstanding recommendations that have not yet been corrected.
VI.C. Safety Training Based on Workers’ Compensation InjuriesProvide information regarding safety training conducted as a result of workers’ compensation claims, injury trends, or identified safety concerns.
VI.C.1. The report should identify:
VI.C.1.a. Number of departments receiving safety training each year.
VI.C.1.b. Departments receiving the training.
VI.C.1.c. Number of employees trained.
VI.C.1.d. Subjects covered during the training.
VI.C.1.e. Whether training topics were selected based on actual District workers’ compensation injury trends.
VI.C.1.f. Whether the training is offered in both English and Spanish.
VI.C.1.g. Whether attendance and completion records are maintained.
VI.C.1.h. What follow-up is conducted to determine whether the training reduced similar injuries.
VI.D. Workers’ Compensation Claim InvestigationsTRISTAR should explain its process for investigating workers’ compensation claims, particularly claims involving questionable circumstances, conflicting information, repeated injuries, delayed reporting, or other indicators requiring additional investigation.
VI.D.1. The presentation should address:
VI.D.1.a. Who determines whether a claim requires additional investigation.
VI.D.1.b. What criteria or “red flags” trigger an investigation.
VI.D.1.c. Whether investigations are conducted telephonically, in person, or through a combination of both methods.
VI.D.1.d. Whether employees, supervisors, and witnesses are interviewed.
VI.D.1.e. Whether accident scenes are inspected when appropriate.
VI.D.1.f. Whether photographs, video surveillance, incident reports, medical documentation, witness statements, and other available evidence are reviewed.
VI.D.1.g. Whether outside investigators are utilized and under what circumstances.
VI.D.1.h. What measures TRISTAR takes to identify and reduce questionable or potentially non-compensable claims.
VI.D.1.i. How investigative findings are documented and communicated to the District.
VI.D.1.j. How investigations affect decisions to accept, deny, or further investigate a claim.
VI.E. Claim Denials and OutcomesProvide a three-year comparison, including 2026 year to date, showing:
VI.E.1. Total claims reported
VI.E.2. Claims accepted
VI.E.3. Claims denied.
VI.E.4. Percentage of claims denied.
VI.E.5. Claims initially denied but later accepted.
VI.E.6. Claims disputed or appealed.
VI.E.7. Open claims.
VI.E.8. Closed claims.
VI.E.9. Total paid losses.
VI.E.10. Outstanding reserves.
VI.E.11. Total incurred losses.
VI.F. Requested Action: Presentation and discussion by TRISTAR Risk Management, with supporting loss runs, loss control reports, safety inspection records, training statistics, and claims investigation/denial data provided to the Board for review.
VII. Public Input
VIII. Adjournment