Final enforcement actions taken by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) for December 2010 include fines of up to $78,000.
Division of Workers’ Compensationfinal disciplinary orders for December 2010 (alphabetical order):
American Guarantee & Liability Insurance Company of Schaumburg, Ill.
Order Number: DWC-10-0126
Date of Order: 12/3/2010
Order Final In: December
Action Taken: Fined $30,000
Violation: Failed to timely comply with Commissioner’s order; Failed to pay for preauthorized medical services; Failed to timely initiate TIBs
Business Staffing Inc. of Conroe
Order Number: DWC-10-0151
Date of Order: 12/31/2010
Order Final In: December
Action Taken: Fined $5,000
Violation: Failed to timely respond to Division request for information
Clark, Bliss Watson M.D. of Harlingen
Order Number: DWC-10-0117
Date of Order: 12/3/2010
Order Final In: December
Action Taken: Fined $7,000; Must attend compliance training for doctors and medical office staff
Violation: Failed to timely file the DWC Form-69; Failed to timely file and accurately complete the DWC Form-73
Cochran, Casey, III, D.O. of Austin
Order Number: DWC-10-0119
Date of Order: 12/3/2010
Order Final In: December
Action Taken: Fined $3,000
Violation: Failed to provide proof of filing DWC Form-69 with the carrier via facsimile or electronic transmission
Continental Casualty Company of Chicago, Ill.
Order Number: DWC-10-0136
Date of Order: 12/13/2010
Order Final In: December
Action Taken: Fined $7,000
Violation: Provided insufficient reason for reduction or denial of payment for health care services; Failed to timely take final action on properly completed medical bill
DeBender, John J., M.D. of Houston
Order Number: DWC-10-0120
Date of Order: 12/3/2010
Order Final In: December
Action Taken: Fined $3,000; Must attend compliance training for doctors and medical office staff; Must undergo a Division compliance audit during Fiscal Year 2011 regarding the filing of DWC Form-69s with the carrier; Must submit a compliance report to the Division as part of the audit.
Violation: Failed to timely file DWC Form-69 with the carrier; Failed to file DWC Form-69 with the carrier via facsimile or electronic transmission
Diamond, Howard Gregg M.D. of Richardson
Order Number: DWC-10-0152
Date of Order: 12/31/2010
Order Final In: December
Action Taken: Fined $8,000; Must attend compliance training for doctors and medical office staff; Must submit patient records for review by Division
Violation: Refused four or more Designated Doctor appointments in 90-day period; Failed to timely file a letter of clarification; Failed to timely conduct reexamination; Failed to timely file DWC Form-69; Failed to file DWC Form-69 with the carrier via facsimile or electronic transmission
Gonzalez, Julian Jay M.D. of Houston
Order Number: DWC-10-0139
Date of Order: 12/13/2010
Order Final In: December
Action Taken: Fined $2,000; Must attend compliance training for doctors and medical office staff
Violation: Failed to timely file DWC Form-69; Failed to timely file DWC Form-73; Failed to accurately complete DWC Form-73
Grays, Peter Edward M.D. of Bedford
Order Number: DWC-10-0143
Date of Order: 12/13/2010
Order Final In: December
Action Taken: Fined $1,000; Must provide copy of compliance plan; Must attend compliance training for doctors and medical office staff
Violation: Failed to timely file DWC Form-69; Failed to timely file DWC Form-73; Failed to accurately complete DWC Form-73
Guerra, Francisco Javier, Sr., M.D. of El Paso
Order Number: DWC-10-0146
Date of Order: 12/21/2010
Order Final In: December
Action Taken: Fined $1,000; Must attend compliance training for doctors and medical office staff
Violation: Failed to timely file DWC Form-69; Failed to timely file DWC Form-73; Failed to accurately complete DWC Form-73
Hartford Underwriters Insurance Company of Hartford, Conn.
Order Number: DWC-10-0122
Date of Order: 12/3/2010
Order Final In: December
Action Taken: Fined $78,000
Violation: Failed to comply with an order or decision of the Commissioner; Failed to pay benefits based on opinion of Designated Doctor during pendency of dispute; Failed to take timely action on properly completed medical bill; Failed to pay for preauthorized medical services
Healthsouth Corporation of Birmingham, Ala.
Order Number: DWC-10-0118
Date of Order: 12/3/2010
Order Final In: December
Action Taken: Fined $5,000
Violation: Failed to timely comply with an order or decision of the Commissioner
Houston Independent School District of Houston
Order Number: DWC-10-0137
Date of Order: 12/13/2010
Order Final In: December
Action Taken: Fined $3,000
Violation: Failed to timely initiate IIBs
Jarolimek, Lubor M.D. of Houston
Order Number: DWC-10-0147
Date of Order: 12/21/2010
Order Final In: December
Action Taken: Fined $1,000; Must attend compliance training for doctors and medical office staff
Violation: Failed to timely file DWC Form-69; Failed to timely file DWC Form-73; Failed to accurately complete DWC Form-73
New Hampshire Insurance Company of New York, N.Y.
Order Number: DWC-10-0125
Date of Order: 12/3/2010
Order Final In: December
Action Taken: Fined $40,000
Violation: Failed to pay an order awarding benefits; Failed to comply with order or decision of Commissioner; Failed to pay medical bills according to Division Medical Fee Guidelines; Failed to take timely action on a properly completed medical bill
Nguyen, Peter Minh V. M.D. of Victoria
Order Number: DWC-10-0138
Date of Order: 12/13/2010
Order Final In: December
Action Taken: Fined $3,000
Violation: Failed to timely file DWC Form-69; Failed to file DWC Form-69 with carrier via facsimile or electronic submission; Failed to timely file DWC Form-73
Old Republic Insurance Company of Greensburg, Pa.
Order Number: DWC-10-0124
Date of Order: 12/3/2010
Order Final In: December
Action Taken: Fined $41,000
Violation: Failed to timely respond to a request for reconsideration of a medical bill; Failed to pay for preauthorized services; Failed to timely pay SIBs; Failed to submit accurate medical bill and payment data to Division; Failed to timely pay or dispute a medical bill within 45 days of receipt; Failed to pay in accordance with the Division’s Medical Fee Guidelines.
Old Republic Insurance Company of Chicago, Ill.
Order Number: DWC-10-0145
Date of Order: 12/13/2010
Order Final In: December
Action Taken: Fined $12,500
Violation: Failed to respond to a Division request for information; Failed to timely pay or dispute a medical bill; Provided insufficient reason for reduction or denial of payment for medical services
Osborn, Charles R., D.C. of Waxahachie
Order Number: DWC-10-0121
Date of Order: 12/3/2010
Order Final In: December
Action Taken: Removed from participation in workers’ compensation system as network or non-network health care provider
Violation: Felony conviction; Suspended medical license; Provided treatment that did no comport with Official Disability Guidelines; Billed as Commission on Accreditation of Rehabilitation facility in violation of Division fee guidelines
Saunders, Ralph C., M.D. of Bedford
Order Number: DWC-10-0144
Date of Order: 12/13/2010
Order Final In: December
Action Taken: Fined $15,000
Violation: Failed to timely file DWC Form-69 with the carrier; Failed to file DWC Form-69 with the carrier via facsimile or electronic transmission
Stock, Alexander M.D. of Mineola
Order Number: DWC-10-0116
Date of Order: 12/3/2011
Order Final In: December
Action Taken: Suspended from practice as health care provider in workers’ compensation system; Must attend compliance training for doctors before returning to practice
Violation: Failed to timely file the DWC Form-69; Failed to file DWC Form-69 with carrier via facsimile or electronic submission
Transportation Insurance Company of Chicago, Ill.
Order Number: DWC-10-0135
Date of Order: 12/13/2010
Order Final In: December
Action Taken: Fined $2,000
Violation: Failed to timely take final action on a properly completed medical bill
The Travelers Indemnity Company of Hartford, Conn.
Order Number: DWC-10-0142
Date of Order: 12/13/2010
Order Final In: December
Action Taken: Fined $55,000
Violation: Failed to timely take final action on properly completed medical bill; Failed to sufficiently explain reduction or denial of payment for medical services; Failed to timely initiate TIBs; Failed to pay for preauthorized medical services; Failed to timely respond to a request for reconsideration; Failed to pay a medical bill according to the Act, Rules, DWC Fee and Treatment Guidelines
The Travelers Indemnity Company of Connecticut of Hartford, Conn.
Order Number: DWC-10-0141
Date of Order: 12/13/2010
Order Final In: December
Action Taken: Fined $60,000
Violation: Failed to timely take final action on a properly completed medical bill; Failed to sufficiently explain reduction or denial of payment for health care services; Failed, without good cause, to attend contested case hearing; Failed to timely initiate benefits; Failed to comply with a MDR Decision and Order; Failed to timely respond to a request for reconsideration; Failed to pay a medical bill according to the Act, Rules, DWC Fee and Treatment Guidelines; Failed to continue to pay benefits week to week as and when they accrue; Failed to timely respond to an injured employee’s request for reimbursement of pharmacy expenses
Travelers Property Casualty Company of America of Hartford, Conn.
Order Number: DWC-10-0140
Date of Order: 12/13/2010
Order Final In: December
Action Taken: Fined $20,000
Violation: Failed to comply with a MDR Decision and Order; Failed to pay for preauthorized medical services; Failed to sufficiently explain reduction or denial of payment for medical services
Twin City Fire Insurance Company of Hartford, Conn.
Order Number: DWC-10-0127
Date of Order: 12/3/2010
Order Final In: December
Action Taken: Fined $2,000
Violation: Failed to comply with decision or order of the Commissioner; Failed to pay for preauthorized medical services
Ullico Casualty Company of Washington, D.C.
Order Number: DWC-10-0123
Date of Order: 12/3/2010
Order Final In: December
Action Taken: Fined $2,500
Violation: Failed to timely file the Accident Prevention Services Report
Source: TDI-DWC
Topics Carriers Texas Workers' Compensation Training Development
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