Texas Workers Compensation Division Disciplinary Actions

Texas Division of Workers Compensation Disciplinary Actions - Final Enforcement Orders

2015

Bradley, David D.C. of North Richland Hills
Order Number: DWC-4185
Date of Order:  11/17/2015
Action Taken:  Fined $1,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records; failed to sufficiently respond to a letter of clarification ordered by division


Old Republic Insurance Company of Greensburg, PA
Order Number: DWC-4189
Date of Order:  11/17/2015
Action Taken:  Fined $4,000
Violation:  Failed to timely pay income benefits to injured employees


Rapid Tox Screen, L.L.C. of Plano
Order Number: DWC-4188
Date of Order:  11/17/2015
Action Taken:  Fined $4,000
Violation:  Failed to respond to request for refund from insurance carrier; failed to comply with division order


T.H.E. Insurance Company of Treasure Island, FL
Order Number: DWC-4186
Date of Order:  11/17/2015
Action Taken:  Fined $11,500
Violation:  Failed to process claims in reasonable and prudent manner; failed to timely contact and offer a survey to its policyholder after learning of a work-related fatality


T.H.E. Insurance Company of Treasure Island, FL
Order Number: DWC-4187
Date of Order:  11/17/2015
Action Taken:  Fined $3,000
Violation:  Failed to timely comply with decision of commissioner


TASB Risk Management, Inc. of Austin
Order Number: DWC-4184
Date of Order:  11/17/2015
Action Taken:  Fined $25,000
Violation:  Failed to timely pay income benefits to injured employees


Worrell, John Mays, Jr., M.D. of Midland
Order Number: DWC-4192
Date of Order:  11/18/2015
Action Taken:  Must complete continuing medical education
Violation:  Administered improper, unreasonable or medically unnecessary treatment


ACS Primary Care Physicians Southwest PA of Cincinnati, OH
Order Number: DWC-4146
Date of Order:  10/9/2015
Action Taken:  Fined $3,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided.


American Guarantee and Liability Insurance Company of Schaumburg, IL
Order Number: DWC-4147
Date of Order:  10/9/2015
Action Taken:  Fined $6,000
Violation:  Failed to accurately pay lifetime income benefits to injured employees on two claims


City of Houston of Houston
Order Number: DWC-4164
Date of Order:  10/28/2015
Action Taken:  Fined $2,000
Violation:  Failed to timely pay attorney fees


Coolbaugh, Robert J., D.C. of Lubbock
Order Number: DWC-4141
Date of Order:  10/7/2015
Action Taken:  (SOAH DOCKET NO. 454-14-3930.C1) Fined $10,000
Violation:  Failed to timely comply with division orders


Hood, James Furniss M.D. of Houston
Order Number: DWC-4145
Date of Order:  10/9/2015
Action Taken:  Must complete designated doctor training
Violation:  Failed to properly determine and report maximum medical improvement certification date and to appropriately report and accurately assign a whole body impairment rating for injured employee


Markel Insurance Company of Glen Allen, VA
Order Number: DWC-4165
Date of Order:  10/28/2015
Action Taken:  Fined $10,000
Violation:  Failed to timely act on a properly completed medical bill; failed to submit accurate medical EDI records to the Division


National Interstate Insurance Company of Richfield, OH
Order Number: DWC-4148
Date of Order:  10/9/2015
Action Taken:  Fined $15,000
Violation:  Failed to accurately pay death benefits; failed to provide accurate claim data to Division


New Hampshire Insurance Company of New York, NY
Order Number: DWC-4134
Date of Order:  10/2/2015
Action Taken:  Fined $7,000
Violation:  Failed to timely pay income benefits to injured employee


New Hampshire Insurance Company of New York, NY
Order Number: DWC-4137
Date of Order:  10/5/2015
Action Taken:  Fined $8,500
Violation:  Failed to comply with order to timely pay income benefits to injured employee; failed to timely pay attorney's fees; failed to timely act on a properly completed medical bill


Obasi, Patrick Chidi, M.D. of Marshall
Order Number: DWC-4167
Date of Order:  10/28/2015
Action Taken:  Fined $2,000; must not re-apply for designated doctor or maximum medical improvement/impairment rating certification for two years.
Violation:  Deficiencies in examinations of injured employees as part of a medical quality review


Pulido, Christopher, D.C. of Pearland
Order Number: DWC-4144
Date of Order:  10/9/2015
Action Taken:  Fined $2,000
Violation:  Failed to obtain injured employee's agreement before rescheduling a designated doctor examination appointment


Setliff, Michael, D.C. of Laredo
Order Number: DWC-4135
Date of Order:  10/2/2015
Action Taken:  Fined $500; Must complete designated doctor training
Violation:  Failed to adequately complete designated doctor narrative report


Shade, Ronnie D., M.D. of Fort Worth
Order Number: DWC-4170
Date of Order:  10/28/2015
Action Taken:  Fined $500
Violation:  Failed to comply with Division order


Technology Insurance Company, Inc. of New York, NY
Order Number: DWC-4166
Date of Order:  10/28/2015
Action Taken:  Fined $1,500
Violation:  Failed to comply with order to timely pay attorney's fees


Twin City Fire Insurance Company of Hartford, CT
Order Number: DWC-4169
Date of Order:  10/28/2015
Action Taken:  Fined $5,500
Violation:  Failed to timely pay income benefits to injured employee; failed to pay income benefits during the pendency of a dispute


Weigel, Sofia Maristany, M.D. of Dallas
Order Number: DWC-4160
Date of Order:  10/21/2015
Action Taken:  Fined $25,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-4122
Date of Order:  9/22/2015
Action Taken:  Fined $7,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries; failed to timely contact and offer a survey to its policyholder after a work-related fatality


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-4132
Date of Order:  9/25/2015
Action Taken:  Fined $1,200
Violation:  Failed to comply with an order to pay attorney's fees; failed to timely pay attorney's fees


Armstrong, Jarrett H., D.C. of Keller
Order Number: DWC-4116
Date of Order:  9/18/2015
Action Taken:  Fined $500
Violation:  Failed to timely notify TDI-DWC that he had not received medical records; failed to reschedule designated doctor examination


Capitol Emergency Associates, P.A. of Oklahoma City, OK
Order Number: DWC-4121
Date of Order:  9/22/2015
Action Taken:  Fined $4,500
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


City of El Paso of El Paso
Order Number: DWC-4114
Date of Order:  9/16/2015
Action Taken:  Fined $21,000
Violation:  Failed to pay accurate death benefits


Hernandez, Arthur S., M.D. of San Antonio
Order Number: DWC-4113
Date of Order:  9/16/2015
Action Taken:  Fined $5,000; will not provide health care to injured employees in the Texas workers' compensation system or receive any renumeration from the Texas workers’ compensation system
Violation:  Ordered treatment and/or diagnostic testing of an injured employee without documenting justification for the testing


Loper, David W., D.C. of Georgetown
Order Number: DWC-4099
Date of Order:  9/1/2015
Action Taken:  Fined $1,000.
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Miller, Hank K., D.C. of Midlothian
Order Number: DWC-4106
Date of Order:  9/10/2015
Action Taken:  Fined $5,000; must not re-apply for designated doctor certification or maximum medical improvement/impairment rating credentials.
Violation:  Improperly certified maximum medical improvement of an injured employee without performing complete medical examination; failed to file work status report for an injured employee; ordered unnecessary testing and failed to explain rationale for testing during designated doctor examination


Northern Insurance Company of New York of Schaumburg, IL
Order Number: DWC-4111
Date of Order:  9/15/2015
Action Taken:  Fined $2,000
Violation:  Failed to pay accurate lifetime income benefits to an injured employee


Safety National Casualty Corporation of St. Louis, MO
Order Number: DWC-4123
Date of Order:  9/22/2015
Action Taken:  Fined $1,000
Violation:  Failed to comply with an order to pay attorney's fees; failed timely pay attorney's fees


Travelers Indemnity Company of Hartford, CT
Order Number: DWC-4115
Date of Order:  9/16/2015
Action Taken:  Fined $3,000
Violation:  Failed to timely act on a properly completed medical bill


Travelers Indemnity Company of Connecticut of Austin
Order Number: DWC-4105
Date of Order:  9/10/2015
Action Taken:  Fined $60,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries; failed to timely report termination of death benefits to TDI-DWC


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-4112
Date of Order:  9/15/2015
Action Taken:  Fined $15,200
Violation:  Failed to pay accurate lifetime income benefits to injured employees; failed to pay accurate death benefits to injured employees; failed to timely comply with contested case hearing order


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-4082
Date of Order:  8/13/2015
Action Taken:  Fined $9,900
Violation:  Failed to timely pay income benefits to injured employees


Ekeruo, Ijeoma Ananaba M.D. of Houston
Order Number: DWC-4073
Date of Order:  8/4/2015
Action Taken:  Must not re-apply for designated doctor certification or maximum medical improvement/impairment rating certification for five years
Violation:  Failed to timely file TDI-DWC report following examination of injured employee


Franz, Jerry L., M.D. of Irving
Order Number: DWC-4075
Date of Order:  8/7/2015
Action Taken:  Fined $2,000
Violation:  Failed to meet standard of care for chronic pain management for five injured employees


Sentry Insurance, A Mutual Company of Stevens Point, WI
Order Number: DWC-4074
Date of Order:  8/4/2015
Action Taken:  Fined $20,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries;failed to provide accurate claims data to TDI-DWC; failed to timely notify TDI-DWC of annual increases in lifetime income benefits


Tays, Cynthia Lysne D.C. of Austin
Order Number: DWC-4086
Date of Order:  8/19/2015
Action Taken:  Fined $2,000; must complete continuing medical education hours in addition to those required for chiropractic licensure renewal
Violation:  Submitted medical bill for an examination of an injured employee that was not performed


The Travelers Indemnity Company of Hartford, CT
Order Number: DWC-4077
Date of Order:  8/11/2015
Action Taken:  Fined $7,500
Violation:  Failed to timely pay accrued income benefits to injured employees; failed to timely pay benefits to injured employee


American Home Assurance Company of New York, NY
Order Number: DWC-4033
Date of Order:  7/2/2015
Action Taken:  Fined $90,000; audit to be performed by September 1, 2015
Violation:  Failed to pay accurate lifetime income benefits to injured employees; failed to pay accurate death benefits to legal beneficiaries; failed to provide accurate claim data to TDI-DWC; failed to timely notify TDI-DWC of annual lifetime income benefits increases


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-4036
Date of Order:  7/2/2015
Action Taken:  Fined $19,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries; failed to provide accurate claim data to TDI-DWC; failed to timely report termination of death benefits to TDI-DWC; failed to timely act on a request for reconsideration


Batlle, Francisco M.D. of Dallas
Order Number: DWC-4050
Date of Order:  7/17/2015
Action Taken:  Must complete additional continuing medical education
Violation:  Failed to complete a fair and reasonable evaluation of an injured employee


Burke, Terry Lee D.C. of Houston
Order Number: DWC-4064
Date of Order:  7/29/2015
Action Taken:  Fined $1,000
Violation:  Failed to obtain agreement from injured employee before rescheduling a designated doctor examination


Carter, Stephen A., M.D. of San Antonio
Order Number: DWC-4065
Date of Order:  7/29/2015
Action Taken:  Fined $500; must complete designated doctor training
Violation:  Improperly certified maximum medical improvement of an injured employee while failing to complete medical examination; failed to explain rationale for testing in designated doctor examinations


Case, Charles Frank D.C. of Austin
Order Number: DWC-4058
Date of Order:  7/27/2015
Action Taken:  Will not re-apply for designated doctor certification or maximum medical improvement/impairment rating certification for five years
Violation:  Failed to complete a fair and reasonable evaluation of an injured employee ; made unnecessary referrals; failed to timely file report of medical evaluation and narrative report


CST Services, L.L.C. of San Antonio
Order Number: DWC-4059
Date of Order:  7/27/2015
Action Taken:  Fined $10,000
Violation:  Failed to timely submit non-subscriber notice of non-coverage; failed to timely file report of non-covered employee's occupational injury or disease


ESIS, Inc. of Philadelphia, PA
Order Number: DWC-4037
Date of Order:  7/2/2015
Action Taken:  Fined $18,000; must cease and desist from performing utilization review without a certificate of registration
Violation:  Conducted utilization review without a certificate of registration; failed to conduct utilization review under direction of a licensed physician; used improper personnel to make medical necessity determinations

Lee, Randi D.C. of Houston
Order Number: DWC-4051
Date of Order:  7/17/2015
Action Taken:  Fined $2,000
Violation:  Failed to timely contact injured employee to cancel designated doctor examination; failed to timely reschedule examination; failed to notify TDI-DWC that examination could not be timely rescheduled


New Hampshire Insurance Company of New York City, NY
Order Number: DWC-4056
Date of Order:  7/27/2015
Action Taken:  Fined $34,000
Violation:  Failed to provide a sufficient and reasonable explanation for reduction or denial of payment of medical bills; failed to timely pay income benefits in accordance with designated doctor reports; failed to timely pay attorney's fees; failed to timely act on a completed medical bill


PharMerica of Pittsburgh, PA
Order Number: DWC-4057
Date of Order:  7/27/2015
Action Taken:  Fined $2,000
Violation:  Improperly billed an injured employee for workers' compensation services


Physicians and Allied Health of Dallas
Order Number: DWC-4052
Date of Order:  7/17/2015
Action Taken:  Default Order. Fined $8,000
Violation:  Improperly billed an injured employee for workers' compensation services


Transportation Insurance Company of Chicago
Order Number: DWC-4035
Date of Order:  7/2/2015
Action Taken:  Fined $12,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries; failed to provide accurate claim data to TDI-DWC; failed to timely report termination of death benefits to TDI-DWC


Valero Energy Corporation of San Antonio
Order Number: DWC-4032
Date of Order:  7/1/2015
Action Taken:  Fined $2,500
Violation:  Failed to timely file report of non-covered employee's occupational injury or disease


Washington, Ronald J., M.D. of Dallas
Order Number: DWC-4042
Date of Order:  7/7/2015
Action Taken:  Default Order. Fined $7,500; must complete medical training in pharmacology and prescribing
Violation:  Administered improper, unreasonable or medically unnecessary treatment by continuing to prescribe medications without documenting justification and risk factors


Wausau Underwriters Insurance Company of Boston, MA
Order Number: DWC-4060
Date of Order:  7/27/2015
Action Taken:  Fined $8,000
Violation:  Failed to timely pay income benefits to injured employee; failed to accurately notify TDI-DWC and injured employee of actions taken on a claim


American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-3995
Date of Order:  6/3/2015
Action Taken:  Fined $9,000
Violation:  Failed to timely pay income benefits to injured employee


Arredondo, Eradio M.D. of San Antonio
Order Number: DWC-3998
Date of Order:  6/3/2015
Action Taken:  Fined $1,500
Violation:  Improperly rescheduled designated doctor examination without contacting injured employee


Cherokee Insurance Company of Sterling Heights, MI
Order Number: DWC-4024
Date of Order:  6/29/2015
Action Taken:  Fined $2,500
Violation:  Failed to timely report payment of income benefits to injured employee to TDI-DWC; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim


Continental Casualty Company of Chicago, IL
Order Number: DWC-4025
Date of Order:  6/29/2015
Action Taken:  Fined $3,000
Violation:  Failed to timely process and take final action on a completed medical bill


Cordas, Stevane D.O. of Hurst
Order Number: DWC-4000
Date of Order:  6/3/2015
Action Taken:  Fined $2,000
Violation:  Conducted a required medical examination (RME) at an inappropriate location


Dirksen, Nathaniel D.C. of Austin
Order Number: DWC-4021
Date of Order:  6/29/2015
Action Taken:  Fined $1,500
Violation:  Improperly rescheduled designated doctor examination without contacting injured employee


Glass, Raymond Keith D.C. of Houston
Order Number: DWC-3997
Date of Order:  6/3/2015
Action Taken:  Fined $2,000; Must complete four hours of continuing medical education in ethics
Violation:  Submitted a medical bill for a functional capacity evaluation which was not performed and was not in accordance with Medicare policies


Liberty Insurance Corporation of Boston, MA
Order Number: DWC-4026
Date of Order:  6/29/2015
Action Taken:  Fined $6,000
Violation:  Failed to timely pay income benefits to injured employee


Medical Center of Plano of Irving
Order Number: DWC-4005
Date of Order:  6/5/2015
Action Taken:  Fined $2,000
Violation:  Improperly billed employer for services covered by workers' compensation insurance; Failed to timely provide medical records of an injured employee after receiving valid order to produce them


Starbucks Corporation of Seattle, WA
Order Number: DWC-4027
Date of Order:  6/29/2015
Action Taken:  Fined $1,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim


Stenson, Derrick James D.C. of Houston
Order Number: DWC-3996
Date of Order:  6/3/2015
Action Taken:  Fined $2,000
Violation:  Submitted a medical bill for a functional capacity evaluation which was not performed and was not in accordance with Medicare billing policies


Texas Mutual Insurance Company of Austin
Order Number: DWC-4020
Date of Order:  6/29/2015
Action Taken:  Fined $8,000
Violation:  Failed to timely complete or return an incomplete medical bill; Failed to timely pay income benefits to an injured employee; Failed to timely notify injured employee of termination or suspension of income benefits; Improperly denied designated doctor medical bill


Trinh, Tuan Anh D.O. of Dallas
Order Number: DWC-4004
Date of Order:  6/5/2015
Action Taken:  Fined $2,500; Must attend medical record documentation course and complete four hours continuing medical education in ethics.
Violation:  Failed to provide health care or meaningful diagnosis to injured employee; Failed to attempt to return injured employee to work


Trumball Insurance Company of Hartford, CT
Order Number: DWC-4023
Date of Order:  6/29/2015
Action Taken:  Fined $8,600
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim


Wausau Underwriters Insurance Company of Boston, MA
Order Number: DWC-3999
Date of Order:  6/3/2015
Action Taken:  Fined $2,000
Violation:  Failed to timely act on a properly completed medical bill


Zurich American Insurance Company of Schaumberg, IL
Order Number: DWC-4003
Date of Order:  6/5/2015
Action Taken:  Fined $90,000
Violation:  Failed to accurately pay income benefits to injured employee; Failed to accurately pay death benefits to legal beneficiaries; Provided inaccurate claim data to TDI-DWC


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-4022
Date of Order:  6/29/2015
Action Taken:  Fined $1,800
Violation:  Failed to timely pay income benefits to injured employee in accordance with Designated Doctor report


Ace American Insurance Company of Wilmington, DE
Order Number: DWC-3964
Date of Order:  5/15/2015
Action Taken:  Fined $6,000; Claims adjuster must complete additional continuing education hours specified by TDI-DWC
Violation:  Refused to accept medical bills submitted electronically by health care providers


Ace American Insurance Company of Wilmington, DE
Order Number: DWC-3966
Date of Order:  5/15/2015
Action Taken:  Fined $16,000
Violation:  Failed to pay accrued and unpaid income benefits within five days of filing its appeal; Failed to contact its policyholder within 7 days of a work-related fatality


Dunn, Thomas P.T. of Bellaire
Order Number: DWC-3973
Date of Order:  5/19/2015
Action Taken:  Fined $50,000; Agrees to cease participation in the Texas workers' compensation system and to not receive direct or indirect renumeration from the Texas Workers' Compensation System
Violation:  Improperly billed for services provided to injured employees


Great Midwest Insurance Company of Houston
Order Number: DWC-3946
Date of Order:  5/6/2015
Action Taken:  Fined $1,500
Violation:  Failed to timely act on a request for preauthorization of health care services for injured employee


Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-3945
Date of Order:  5/6/2015
Action Taken:  Fined $9,000
Violation:  Failed to timely pay benefits to injured employee based on opinion of designated doctor


Indemnity Insurance Company of North America of Philadelphia
Order Number: DWC-3976
Date of Order:  5/22/2015
Action Taken:  Fined $6,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to pay benefits based on opinion of designate doctor during pendency of dispute


Indemnity Insurance Company of North America of Phladelphia, PA
Order Number: DWC-3972
Date of Order:  5/19/2015
Action Taken:  Fined $49,000
Violation:  Failed to accurately pay lifetime income benefits and death benefits; Failed to provide accurate and timely claims data to the division; Failed to contact its policyholder within 7 days of a work-related fatality


Key, James David, Sr., M.D. of Brownsville
Order Number: DWC-3971
Date of Order:  5/19/2015
Action Taken:  Fined $75,000; Must not participate in treating or examining injured employees covered in the Texas workers' compensation system and/or consult with other physicians regarding injured employees in the system; Cannot receive direct or indirect remuneration from the Texas workers’ compensation system
Violation:  Improperly billed for services provided to injured employees


Liberty Mutual Insurance Company of Plymouth Meeting, PA
Order Number: DWC-3947
Date of Order:  5/6/2015
Action Taken:  Fined $2,000
Violation:  Prospectively denied future medical benefits for injured employee


Old Republic Insurance Company of Greensburg, PA
Order Number: DWC-3983
Date of Order:  5/26/2015
Action Taken:  Fined $5,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to pay benefits based on opinion of designated doctor during pendency of dispute


Smith, Stephen Lynn D.O. of Fredericksburg
Order Number: DWC-3948
Date of Order:  5/6/2015
Action Taken:  Fined $2,000
Violation:  Used unprofessional and inappropriate language in a document directed at a workers' compensation system participant


State Farm Fire and Casualty Company of Bloomington, IL
Order Number: DWC-3960
Date of Order:  5/12/2015
Action Taken:  Fined $5,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim; Failed to timely report initial payment of benefits to TDI-DWC


The Travelers Indemnity Company of Hartford, CT
Order Number: DWC-3965
Date of Order:  5/15/2015
Action Taken:  Fined $500
Violation:  Failed to provide sufficient explanation for reduction or denial of a medical bill


Youngblood, Tonya Joyce M.D. of Ennis
Order Number: DWC-3982
Date of Order:  5/26/2015
Action Taken:  Fined $2,000; Must complete additional continuing education hours
Violation:  Submitted a medical bill for services that were not performed and were not in accordance with applicable Medicare billing policies


Commerce and Industry Insurance Company of New York, NY
Order Number: DWC-3891
Date of Order:  4/2/2015
Action Taken:  Fined $34,000
Violation:  Failed to accurately pay income and death benefits; Failed to timely submit claims data to TDI-DWC


Contnental Casualty Company of Chicago, IL
Order Number: DWC-3907
Date of Order:  4/14/2015
Action Taken:  Fined $3,000
Violation:  Failed to timely pay or act on injured employees' request for reimbursement of pharmaceutical expenses


Corley, Ronald G., M.D. of Lufkin
Order Number: DWC-3913
Date of Order:  4/16/2015
Action Taken:  Permanently removed from designated doctor list and MMI/IR certification and may not reapply for designated doctor list
Violation:  Failed to comply with requirements for designated doctor examinations


Cummings, Eliseo D.C. of Conroe
Order Number: DWC-3893
Date of Order:  4/2/2015
Action Taken:  Fined $2,500
Violation:  Failed to comply with requirements for the location of designated doctor examinations


Five Points Health of El Paso
Order Number: DWC-3911
Date of Order:  4/16/2015
Action Taken:  Fined $1,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Liberty Insurance Corporation of Boston, MA
Order Number: DWC-3908
Date of Order:  4/14/2015
Action Taken:  Fined $32,000
Violation:  Failed to accurately pay income benefits to injured employees; Failed to accurately pay death benefits; Failed to provide accurate claim data to TDI-DWC; Failed to timely pay or act on injured employees' request for reimbursement


Mussaji, Murtaza, D.O. of Houston
Order Number: DWC-3899
Date of Order:  4/7/2015
Action Taken:  Must not apply for admission to designated doctor list for two years.
Violation:  Failed to comply with requirements for documenting impairment rating and designated doctor examinations


New Hampshire Insurance Company of New York City, NY
Order Number: DWC-3892
Date of Order:  4/2/2015
Action Taken:  Fined $19,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely act on a properly completed medical bill; Failed to properly complete a request for designated doctor examination; Failed to timely comply with TDI-DWC order


Old Republic General Insurance Corporation of Chicago, IL
Order Number: DWC-3939
Date of Order:  4/30/2015
Action Taken:  Fined $2,000
Violation:  Failed to list all injuries determined to be compensable by TDI-DWC when requesting designated doctor examination


QAVU PLLC of Kingwood
Order Number: DWC-3934
Date of Order:  4/28/2015
Action Taken:  Fined $2,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Rodgers, Jerry M.D. of Point
Order Number: DWC-3932
Date of Order:  4/24/2015
Action Taken:  Must not apply for admission to the designated doctor list for three years
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports and records

Safety National Casualty Corporation of St. Louis, MO
Order Number: DWC-3909
Date of Order:  4/14/2015
Action Taken:  Fined $5,000
Violation:  Failed to timely pay accrued income benefits to an injured employee after receipt of designated doctor's report; Failed to timely pay income benefits to an injured employee


Shaw-Rice, Judi Ann M.D. of Houston, TX
Order Number: DWC-3890
Date of Order:  4/2/2015
Action Taken:  Fined $4,000; Must not re-apply for designated doctor certification; Must surrender maximum medical improvement/impairment rating credentials
Violation:  Failed to inform TDI-DWC of disciplinary actions taken by Texas Medical Board; Failed to timely file designated doctors' reports following examination of injured employees


Soriano, Ramon M.D. of Laredo
Order Number: DWC-3938
Date of Order:  4/30/2015
Action Taken:  Fined $2,000; Must complete continuing medical education, medical record keeping and documentation training and ethics training;
Violation:  Diagnosis, treatment and evaluations of injured employee substantially different from those found to be fair and reasonable; Provided improper, unreasonable or medically unnecessary treatment or services; Failed to approve or recommend all health care reasonably required for injured employee


Southeast Service Corporation of Chesterbrook, PA
Order Number: DWC-3918
Date of Order:  4/29/2015
Action Taken:  Fined $1,000
Violation:  Failed to respond to a request for information from TDI-DWC


Taxis, John O., D.O. of Sugar Land, TX
Order Number: DWC-3912
Date of Order:  4/16/2015
Action Taken:  Must not re-apply for designated doctor certification; Must surrender maximum medical improvement/impairment rating credentials
Violation:  Failed to comply with requirements for documenting impairment rating and designated doctor examinations


American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-3857
Date of Order:  3/11/2015
Action Taken:  Fined $3,000
Violation:  Failed to take final action on a complete medical bill


Atkins, Ernie Lee D.O. of San Antonio
Order Number: DWC-3868
Date of Order:  3/23/2015
Action Taken:  Fined $4,000
Violation:  Failed to timely provide designated doctor with injured employee's medical records; Failed to timely comply with a division order to produce documents


Carter, Jerome Oliver M.D. of Houston
Order Number: DWC-3867
Date of Order:  3/20/2015
Action Taken:  Fined $3,000
Violation:  Failed to comply with Commissioner rule; Failed to timely respond to request for clarification


Radiology Associates of North Texas of Fort Worth
Order Number: DWC-3879
Date of Order:  3/30/2015
Action Taken:  Fined $4,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Rochdale Insurance Company of New York, NY
Order Number: DWC-3856
Date of Order:  3/11/2015
Action Taken:  Fined $1,600
Violation:  Failed to timely comply with order for advance payment of income benefits


ACE American Insurance Company of Wilmington, DE
Order Number: DWC-3822
Date of Order:  2/18/2015
Action Taken:  Total Sanction: $250,000, including an administrative penalty of $100,000; adoption of an enhanced compliance plan, including an investment of at least $50,000 toward implementing the compliance plan; establishment and an initial donation of $100,000 for a Texas branch of the Kids Chance charity, which provides educational opportunities and assistance to families affected by workplace fatalities; and participation in all upcoming TDI-DWC audits for a period of three years.
Violation:  Failed to timely pay death benefits to eligible beneficiaries; Failed to timely pay interest on accrued death benefits; Failed to timely take action on a request for burial benefits; Failed to timely and accurately notify TDI-DWC of actions taken on a claim.


Arrowood Indemnity Company of Charlotte, NC
Order Number: DWC-3837
Date of Order:  2/26/2015
Action Taken:  Fined $13,500
Violation:  Failed to timely submit medical bill and payment data to TDI-DWC.


Cho, Mickey Seong M.D. of San Antonio
Order Number: DWC-3806
Date of Order:  2/4/2015
Action Taken:  Must complete designated doctor (DD) training and pass DD certification test within 120 days.
Violation:  Documented an inadequate designated doctor examination report, including failure to explain analysis performed to establish maximum medical improvement (MMI) date, and failure to analyze specific clinical findings to determine impairment rating (IR) assignments.


Employers Assurance Company of Reno, NV
Order Number: DWC-3839
Date of Order:  2/26/2015
Action Taken:  Fined $1,200
Violation:  Failed to timely pay accrued income benefits after receiving designated doctors certifying report.


Employers Insurance Company of Wausau of Boston, MA
Order Number: DWC-3802
Date of Order:  2/3/2015
Action Taken:  Fined $4,000
Violation:  Failed to timely pay income benefits to injured employee.


Fernando, Savithri M.D. of Edna
Order Number: DWC-3800
Date of Order:  2/3/2015
Action Taken:  Fined $1,000; Must complete pharmacology and prescribing training and continuing medical education related to medical guidelines.
Violation:  Failed to use TDI-DWC adopted MDA return-to-work guidelines to establish goals and return to work plan for safely returning injured employees to work; Failed to document how employee’s injuries prevented return to work; Diagnoses, treatment and evaluations were substantially different from those found fair and reasonable by commissioner.


Fisher, Deborah M.D. of Sherman
Order Number: DWC-3801
Date of Order:  2/3/2015
Action Taken:  Must complete continuing medical education in medical record keeping and documentation; Must complete medical training in pharmacology and prescribing.
Violation:  Diagnoses, treatment or evaluation substantially different from those found fair and reasonable by commissioner; Administered unreasonable or medically unnecessary treatment or services.


Kersh, Frederick W., D.O. of Tyler
Order Number: DWC-3811
Date of Order:  2/9/2015
Action Taken:  Must complete maximum medical improvement (MMI) and impairment (IR) certification training within 120 days; must complete core competency workshop; must complete continuing medical education in medical record keeping.
Violation:  Failed to determine impairment rating (IR) that included injured employee's lumbar vertebral fractures; Administered improper, unreasonable or medically unnecessary treatment or services to injured employee.


Lozano, Pedro Julio D.C. of Galveston
Order Number: DWC-3823
Date of Order:  2/18/2015
Action Taken:  Fined $1,000
Violation:  Failed to document in designated doctor narrative report sufficient explanation of conditions for injured employee to return to work; Failed to file designated doctor narrative report in form and manner required by TDI-DWC.


Rayfield, Dennis Scott D.C. of Plano
Order Number: DWC-3838
Date of Order:  2/26/2015
Action Taken:  Fined $2,000
Violation:  Improperly rescheduled a designated doctor examination; Performed designated doctor examination without reviewing treating doctor's medical records for injured employee.


The Travelers Indemnity Company of Morrissville, NC
Order Number: DWC-3819
Date of Order:  2/17/2015
Action Taken:  Fined $10,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely pay benefits based on opinion of designated doctor during pendency of dispute.


Valley Forge Insurance Company of Chicago, IL
Order Number: DWC-3818
Date of Order:  2/13/2015
Action Taken:  Fined $30,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries; Failed to timely report termination of death benefits to TDI-DWC; Failed to provide accurate claim data to TDI-DWC; Failed to timely pay benefits based on opinion of designated doctor during pendency of a dispute.


AIG Property Casualty Company of New York, NY
Order Number: DWC-3783
Date of Order:  1/20/2015
Action Taken:  Fined $8,500
Violation:  Failed to timely act on a properly completed medical bill; Failed to timely and accurately submit medical electronic data interchange ( EDI) records to TDI-DWC


Alexander, Richard D.C. of San Antonio
Order Number: DWC-3763
Date of Order:  1/6/2015
Action Taken:  Fined $3,000; Must complete continuing education and submit documentation of completion to TDI-DWC
Violation:  Failed to complete continuing education requirements in previous order; Failed to timely pay administration penalty in previous order


American Economy Insurance Company of Boston, MA
Order Number: DWC-3784
Date of Order:  1/20/2015
Action Taken:  Fined $4,000
Violation:  Failed to timely comply with Medical Fee Dispute Resolution order


Ascension Health of St. Louis, MO
Order Number: DWC-3772
Date of Order:  1/12/2015
Action Taken:  Fined $19,500
Violation:  Failed to timely act on a properly completed medical bill; Failed to timely and accurately submit medical electronic data interchange (EDI) records to TDI-DWC


Illinois National Insurance Company of New York, NY
Order Number: DWC-3762
Date of Order:  1/6/2015
Action Taken:  Fined $8,000
Violation:  Failed to timely submit medical bill and payment data to TDI-DWC; Failed to submit accurate medical electronic data interchange (EDI) records to TDI-DWC; Failed to respond to health care provider's request for preauthorization


Liberty Insurance Corporation of Boston, MA
Order Number: DWC-3791
Date of Order:  1/27/2015
Action Taken:  Fined $20,000
Violation:  Failed to timely pay initial temporary income benefits and timely and/or accurately report the initial income benefit payment data to TDI-DWC


Medical Center of Arlington of Arlington
Order Number: DWC-3790
Date of Order:  1/27/2015
Action Taken:  Fined $4,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Odom, Timothy E., D.C. of North Richland Hills
Order Number: DWC-3780
Date of Order:  1/20/2015
Action Taken:  Fined $1,200; Prohibited from applying for admission to designated doctor list or for MMI/IR certification for three years
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Olivares, Adrian D.C. of North Richland Hills
Order Number: DWC-3781
Date of Order:  1/20/2015
Action Taken:  Fined $1,500
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Rodrigues, Stephen S., M.D. of Dallas
Order Number: DWC-3782
Date of Order:  1/20/2015
Action Taken:  Permanently removed from Texas workers' compensation system as a health care provider
Violation:  Provided diagnoses, treatment or evaluations substantially different from those found to be fair and reasonable by commissioner in Texas workers' compensation system


Thompson, Daniel O., III, M.D. of Keller
Order Number: DWC-3771
Date of Order:  1/12/2015
Action Taken:  Fined $3,500; Must cease designated doctor examinations in noncompliant facilities; Must complete designated doctor training
Violation:  Failed to follow treatment guidelines in designated doctor and maximum medical improvement examinations of injured employees


Travelers Casualty and Surety Company of Hartford, CT
Order Number: DWC-3773
Date of Order:  1/12/2015
Action Taken:  Fined $8,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim; Failed to timely report initial payment of income benefits


Travelers Indemnity Company of Hartford, CT
Order Number: DWC-3774
Date of Order:  1/12/2015
Action Taken:  Fined $10,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim; Failed timely report initial payment on indemnity benefits


Vargas, Norberto Juan M.D. of Sunnyvale
Order Number: DWC-3789
Date of Order:  1/27/2015
Action Taken:  Fined $1,000; Must complete medical recordkeeping training
Violation:  Failed to practice medicine or provide health care consistent with public health, safety and welfare; Administered unreasonable or medically unnecessary treatment or services

2014

Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-3743
Date of Order:  12/19/2014
Action Taken:  Fined $1,000
Violation:  Failed to provide list of all injured worker injuries determined to be compensable by TDI-DWC or as accepted as compensable by insurance carrier


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-3696
Date of Order:  12/2/2014
Action Taken:  Fined $700
Violation:  Failed to timely comply with an order for advance payment of income benefits to injured employee


Chubb Indemnity Insurance Company of Warren, NJ
Order Number: DWC-3714
Date of Order:  12/11/2014
Action Taken:  Fined $9,000
Violation:  Failed to timely pay benefits based on the opinion of designated doctor during pendency of a dispute


City of Houston of Houston
Order Number: DWC-3752
Date of Order:  12/23/2014
Action Taken:  Fined $8,000
Violation:  Failed to comply with benefit dispute agreement


Dallas Medical Center of Dallas
Order Number: DWC-3695
Date of Order:  12/2/2014
Action Taken:  Fined $15,000
Violation:  Failed to respond to a request for a refund from insurance carrier


Eaves, Jason L., D.C. of San Antonio
Order Number: DWC-3729
Date of Order:  12/18/2014
Action Taken:  Fined $1,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


El Paso Orthopedic Surgery Center of El Paso
Order Number: DWC-3730
Date of Order:  12/18/2014
Action Taken:  Fined $2,000
Violation:  Improperly billed an injured employee for wrokers' compensation medical services provided


Everest National Insurance Company of Liberty Corner, NJ
Order Number: DWC-3742
Date of Order:  12/19/2014
Action Taken:  Fined $25,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to timely submit accurate medical EDI records to TDI-DWC


Federal Insurance Company of Warren, NJ
Order Number: DWC-3713
Date of Order:  12/11/2014
Action Taken:  Fined $4,000
Violation:  Failed to timely pay income benefits to injured employee


Genesis Insurance Company of Stamford, CT
Order Number: DWC-3741
Date of Order:  12/19/2014
Action Taken:  Fined $35,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI bills to TDI-DWC


Great Midwest Insurance Company of Houston
Order Number: DWC-3740
Date of Order:  12/19/2014
Action Taken:  Fined $3,400
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim


Kinnison, David Wayne D.C. of North Richland Hills
Order Number: DWC-3739
Date of Order:  12/19/2014
Action Taken:  Fined $1,000; Cannot apply or reapply for certification as a designated doctor until after March 31, 2017
Violation:  Failed to timely respond to request for clarification


Liberty Insurance Corporation of Irving
Order Number: DWC-3697
Date of Order:  12/2/2014
Action Taken:  Fined $9,000
Violation:  Failed to pay benefits in accordance with designated doctor's opinion; Failed to timely comply with TDI-DWC decision and order


Medical Center of Arlington of Arlington
Order Number: DWC-3731
Date of Order:  12/18/2014
Action Taken:  Fined $4,000
Violation:  Improperly pursued a private claim against an employer; Failed to comply with an Order to Produce


New Hampshire Insurance Company of New York, NY
Order Number: DWC-3698
Date of Order:  12/2/2014
Action Taken:  Fined $89,000
Violation:  Failed to timely submit accurate medical bill and payment EDI records to TDI-DWC; Failed to timely pay income benefits to injured employee; Failed to take action on a properly completed medical bill; Failed to timely process a travel reimbursement request; Failed to timely process a completed medical bill; Failed to timely submit accurate medical EDI records to TDI-DWC; Failed to timely provide information requested by an injured employee; Failed to timely pay attorney's fees; Failed to provide list of all injured worker injuries determined to be compensable by TDI-DWC or as accepted as compensable by insurance carrier; Failed to timely pay in accordance with a Benefit Dispute Agreement; Failed to report to TDI-DWC the initial payment of income benefits


Phoenix Insurance Company of Hartford, CT
Order Number: DWC-3732
Date of Order:  12/18/2014
Action Taken:  Fined $5,750
Violation:  Failed to timely pay temporary income benefits to injured employee; Failed to accurately report income benefits data to TDI-DWC


Prentice, Kevin Lee D.C. of Lewisville
Order Number: DWC-3694
Date of Order:  12/2/2014
Action Taken:  Fined $2,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Property and Casualty Insurance Company of Hartford of Hartford, CT
Order Number: DWC-3749
Date of Order:  12/22/2014
Action Taken:  Fined $8,000
Violation:  Failed to timely pay benefits in accordance with designated doctor's opinion


Protective Insurance Company of Carmel, IN
Order Number: DWC-3699
Date of Order:  12/2/2014
Action Taken:  Fined $9,000
Violation:  Failed to timely pay temporary income benefits to injured employee; Failed to timely notify TDI-DWC and injured employee of actions taken on a claim


Quiroz, Juan Francisco M.D. of Sunnyvale
Order Number: DWC-3690
Date of Order:  12/1/2014
Action Taken:  Fined $750
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


SeaBright Insurance Company of Seattle, WA
Order Number: DWC-3744
Date of Order:  12/19/2014
Action Taken:  Fined $16,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to timely submit accurate medical EDI records to TDI-DWC


Sentry Casualty Company of Stevens Point, WI
Order Number: DWC-3745
Date of Order:  12/19/2014
Action Taken:  Fined $4,400
Violation:  Failed to timely pay temporary income benefits to injured employee; Failed to accurately report benefits and payment data to TDI-DWC


Starr Indemnity & Liability Company of New York, NY
Order Number: DWC-3751
Date of Order:  12/23/2014
Action Taken:  Fined $5,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim


Technology Insurance Company of New York, NY
Order Number: DWC-3733
Date of Order:  12/18/2014
Action Taken:  Fined $9,000
Violation:  Failed to timely pay temporary income benefits to injured employee; Failed to timely notify TDI-DWC and injured employee of actions taken on a claim


Texas Mutual Insurance Company of Austin
Order Number: DWC-3746
Date of Order:  12/19/2014
Action Taken:  Fined $12,000
Violation:  Failed to timely comply with a commissioner's order to produce information; Failed to notify the division of refusal to pay a medical bill; Failed to timely pay impairment benefits based on a designated doctor's opinion


Texas Public School Workers' Compensation Project of Plano
Order Number: DWC-3700
Date of Order:  12/2/2014
Action Taken:  Fined $7,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely notify TDI-DWC and injured employee of actions taken on a claim


Twin City Fire Insurance Company of Hartford, CT
Order Number: DWC-3701
Date of Order:  12/2/2014
Action Taken:  Fined $3,000
Violation:  Failed to comply with TDI-DWC order


Valley Forge Insurance Company of Chicago, IL
Order Number: DWC-3748
Date of Order:  12/19/2014
Action Taken:  Fined $6,000
Violation:  Failed to timely pay temporary income benefits to injured employee; Failed to accurately report initial temporary income data to TDI-DWC


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-3712
Date of Order:  12/11/2014
Action Taken:  Fined $3,400
Violation:  Failed to timely issue payment to health care provider


Accident Fund General Insurance Company of Lansing, MI
Order Number: DWC-3671
Date of Order:  11/18/2014
Action Taken:  Fined $28,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI records to TDI-DWC


American Home Assurance Company of New York City, NY
Order Number: DWC-3672
Date of Order:  11/18/2014
Action Taken:  Fined $2,000
Violation:  Failed to timely act on a properly completed medical bill


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-3673
Date of Order:  11/18/2014
Action Taken:  Fined $10,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to timely submit accurate medical EDI records to TDI-DWC


Beman, Douglas L., D.C. of Fort Worth
Order Number: DWC-3683
Date of Order:  11/19/2014
Action Taken:  Fined $1,000; Must complete medical training
Violation:  Failed to provide acceptable health care to injured employee including: Improperly utilized diagnostic tests not supported by medical record or evidence-based criteria


Halaby, Gerald A., M.D. of Houston
Order Number: DWC-3670
Date of Order:  11/18/2014
Action Taken:  Must complete medical training including required designated doctor certification
Violation:  Failed to provide acceptable care to injured employee including meeting minimum requirements of designated doctors


Mayorga, Gilbert, Jr., M.D. of Houston
Order Number: DWC-3669
Date of Order:  11/18/2014
Action Taken:  Fined $5,000; Must complete assigned CME courses within 180 days
Violation:  Failed to adequately assess and monitor injured employees in four cases when prescribing opioids; Failed to establish return-to-work goals


Pacific Indemnity Company of Warren, NJ
Order Number: DWC-3674
Date of Order:  11/18/2014
Action Taken:  Fined $3,000
Violation:  Failed to timely act on a properly completed medical bills; Failed to submit accurate medical EDI records to TDI-DWC


Sparta Insurance Company of Hartford, CT
Order Number: DWC-3675
Date of Order:  11/18/2014
Action Taken:  Fined $15,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI records to TDI-DWC


The Netherlands Insurance Company of Boston, MA
Order Number: DWC-3684
Date of Order:  11/19/2014
Action Taken:  Fined $6,000
Violation:  Failed to timely pay benefits to injured employee; Failed to submit accurate payment data to TDI-DWC


Work First Casualty Company of Wilmington, DE
Order Number: DWC-3676
Date of Order:  11/18/2014
Action Taken:  Fined $6,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI records to TDI-DWC


Ace American Insurance Company of Wilmington, DE
Order Number: DWC-3598
Date of Order:  10/22/2014
Action Taken:  Fined $45,000
Violation:  Failed to accurately and timely pay benefits to an injured employee; Failed to accurately pay death benefits; Failed to notify TDI-DWC and injured employee of actions taken on a claim


Caldwell, Rodney Lynn M.D. of Dallas, TX
Order Number: DWC-3591
Date of Order:  10/22/2014
Action Taken:  Fined $3,600
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Cherokee Insurance Company of Sterling Heights, MI
Order Number: DWC-3594
Date of Order:  10/22/2014
Action Taken:  Fined $10,000; Must submit required medical EDI data
Violation:  Failed to timely submit medical bill and payment data via EDI to TDI-DWC


Corpus Christi I.S.D. of Corpus Christi
Order Number: DWC-3595
Date of Order:  10/22/2014
Action Taken:  Fined $3,000
Violation:  Failed to timely issue payment of supplemental income benefits to an injured employee in a subsequent quarter


Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC-3596
Date of Order:  10/22/2014
Action Taken:  Fined $2,500
Violation:  Failed to comply with TDI-DWC order to provide information for a designated doctor examination


Marshall, George Kenneth M.D. of Longview
Order Number: DWC-3592
Date of Order:  10/22/2014
Action Taken:  Must not accept new patients in nor participate in Texas workers' compensation system as a health care provider; Must refer existing patients to other providers
Violation:  Administered improper, unreasonable, or medically unnecessary treatment by treating an injured employee for a diagnosis not supported by the medical record


Newton, Lesley M.D. of Houston
Order Number: DWC-3593
Date of Order:  10/22/2014
Action Taken:  Agrees not to re-apply for designated doctor list nor to apply to certify maximum medical improvement and assign impairment ratings for two years
Violation:  Failed to timely file proper forms and narrative reports following five designated doctor examinations


OneBeacon America Insurance Company of Canton, MA
Order Number: DWC-3573
Date of Order:  10/9/2014
Action Taken:  Fined $5,500
Violation:  Submitted inaccurate medical EDI records to TDI-DWC


Pacific Employers Insurance Company of Philadelphia, PA
Order Number: DWC-3574
Date of Order:  10/9/2014
Action Taken:  Fined $3,000
Violation:  Improperly denied reimbursement based on medical necessity for preauthorized health care


Tarrant County College District of Austin
Order Number: DWC-3575
Date of Order:  10/9/2014
Action Taken:  Fined $9,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI records to TDI-DWC


The Insurance Company of the State of Pennsylvania of New York City, NY
Order Number: DWC-3597
Date of Order:  10/22/2014
Action Taken:  Fined $6,500
Violation:  Failed to timely submit medical bill and payment data via EDI to TDI-DWC; Failed to timely act on an injured employee's request for travel reimbursement

Weeks, Trenton David D.C. of Dallas
Order Number: DWC-3572
Date of Order:  10/9/2014
Action Taken:  Fined $1,000; Must complete medical record documentation training
Violation:  Evaluation of injured employee's work status, ability to work, work restrictions and medical condition deficient and lacked testing description or data to support conclusions


American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-3548
Date of Order:  9/18/2014
Action Taken:  Fined $15,500
Violation:  Failed to timely and accurately notify TDI-DWC and injured employee of actions taken on a claim; Failed to timely pay benefits based on opinion of designated doctor during pendency of dispute; Failed to timely act on a properly completed medical bill; ; failed to properly submit request for designated doctor examination


Burgesser, Mary Francis M.D. of Brookfield, WI
Order Number: DWC-3557
Date of Order:  9/23/2014
Action Taken:  Permanently removed from Texas workers' compensation system as a health care provider
Violation:  Provided treatments and/or evaluations substantially different from those found by commissioner to be fair and reasonable which were based on inadequate medical record documentation


Hartford Insurance Company of the Midwest of Hartford, CT
Order Number: DWC-3534
Date of Order:  9/16/2014
Action Taken:  Fined $40,000
Violation:  Failed to pay income benefits in accordance with designated doctors report; Violated and/or failed or refused to comply with commissioner rule or a provision of Texas Workers' Compensation Act


Holland, Christine Westmoreland M.D. of Decatur
Order Number: DWC-3523
Date of Order:  9/9/2014
Action Taken:  Fined $2,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Marshall, C. Perry M.D, of Tyler
Order Number: DWC-3521
Date of Order:  9/9/2014
Action Taken:  Fined $7,500
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


National Interstate Insurance Company of Richfield, OH
Order Number: DWC-3524
Date of Order:  9/9/2014
Action Taken:  Fined $5,000
Violation:  Failed to timely pay income benefits to injured employee based on opinion of designated doctor during pendency of dispute


Safety National Casualty Corporation of St. Louis, MO
Order Number: DWC-3531
Date of Order:  9/15/2014
Action Taken:  Fined $1,000
Violation:  Failed to timely comply with a decision of the commissioner


Siebenaler, Frank J., Jr., D.C. of Austin
Order Number: DWC-3477
Date of Order:  9/9/2014
Action Taken:  Fined $1,000
Violation:  Submitted information to TDI-DWC that misrepresented an accurate and/or consistent certification date for results of designated doctor examination


The Standard Fire Insurance Company of Hartford, CT
Order Number: DWC-3525
Date of Order:  9/9/2014
Action Taken:  Fined $1,500
Violation:  Failed to properly submit request for designated doctor examination


The Travelers Indemnity Company of Hartford, CT
Order Number: DWC-3533
Date of Order:  9/16/2014
Action Taken:  Fined $11,500
Violation:  Failed to issue timely payment to health care provider; Failed to timely act on request for reconsideration


XL Specialty Insurance Company of Stamford, CT
Order Number: DWC-3526
Date of Order:  9/9/2014
Action Taken:  Fined $8,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim; Failed to timely report initial payment of indemnity benefits to TDI-DWC; Failed to timely act on a properly completed medical bill.


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-3547
Date of Order:  9/18/2014
Action Taken:  Fined $5,500
Violation:  Failed to use TDI-DWC's adopted medical fee guidelines for reimbursement of professional medical service


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-3477
Date of Order:  8/8/2014
Action Taken:  Fined $4,700
Violation:  Failed to timely act on a properly completed medical bill; Failed to timely respond to request from an injured employee; Failed to timely act on request for reconsideration


Behrens Southern Comfort Medical Supply of Galveston
Order Number: DWC-3491
Date of Order:  8/20/2014
Action Taken:  Fined $1,000
Violation:  Improperly billed an injured employee for workers' compensation services provided


Christus Jasper Memorial of Dallas
Order Number: DWC-3492
Date of Order:  8/20/2014
Action Taken:  Fined $2,000
Violation:  Improperly billed an injured employee for workers' compensation services provided


Companion Property and Casualty Insurance Company of Columbia, SC
Order Number: DWC-3494
Date of Order:  8/20/2014
Action Taken:  Fined $28,500
Violation:  Failed to timely process medical bills


Great American Alliance Insurance Company of Cincinnati, OH
Order Number: DWC-3509
Date of Order:  8/27/2014
Action Taken:  Nunc Pro Tunc DWC # 3389
Violation:  Not applicable


Hartford Underwriters Insurance Company of Hartford, CT
Order Number: DWC-3510
Date of Order:  8/27/2014
Action Taken:  Fined $14,000
Violation:  Failed to timely pay income benefits to injured employees


Shade, Ronnie D., M.D. of Dallas
Order Number: DWC-3490
Date of Order:  8/20/2014
Action Taken:  Fined $1,000; Must completed medical records training
Violation:  Failed to use return-to-work guidelines to establish goals and plan with injured employee; Failed to explain in work status report how employee's injury prevented return to work


Texas Health Presbyterian Hospital of Plano of Plano
Order Number: DWC-3493
Date of Order:  8/20/2014
Action Taken:  Fined $4,000
Violation:  Improperly billed and injured employee for workers' compensation services provided


Accident Fund Insurance Company of America of Lansing, MI
Order Number: DWC-3403
Date of Order:  7/10/2014
Action Taken:  Fined $19,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to notify TDI-DWC and injured employee of actions taken on a claim


Ace American Insurance Company of Wilmington, DE
Order Number: DWC-3402
Date of Order:  7/10/2014
Action Taken:  Fined $44,079
Violation:  Failed to submit accurate medical billing and payment data; Failed to timely act on a properly completed medical bill; Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-3420
Date of Order:  7/21/2014
Action Taken:  Fined $4,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit request for designated doctor examination in proper form


Allen I.S.D. of Allen
Order Number: DWC-3419
Date of Order:  7/18/2014
Action Taken:  Fined $12,000
Violation:  Failed to submit accurate medical EDI records to TDI-DWC


American Guarantee and Liability Insurance Company of Schaumburg, IL
Order Number: DWC-3467
Date of Order:  7/31/2014
Action Taken:  Fined $11,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI records to TDI-DWC


American Home Assurance Company of New York, NY
Order Number: DWC-3395
Date of Order:  7/7/2014
Action Taken:  Fined $7,848
Violation:  Failed to submit accurate medical billing and payment data; Failed to timely and accurately notify TDI-DWC of action taken on a claim


Argonaut Insurance Company of San Antonio
Order Number: DWC-3440
Date of Order:  7/28/2014
Action Taken:  Fined $24,000
Violation:  Failed to timely pay income benefits to injured employees as ordered by TDI-DWC


Ascension Health of St. Louis, MO
Order Number: DWC-3439
Date of Order:  7/28/2014
Action Taken:  Fined $5,000
Violation:  Failed to timely pay income benefits to injured employee


Berkshire Hathaway Homestate Insurance Company of Omaha, NE
Order Number: DWC-3404
Date of Order:  7/10/2014
Action Taken:  Fined $32,000
Violation:  Failed to timely act on properly completed medical bill; Failed to accurately submit medical EDI records to TDI-DWC; Failed to timely pay income benefits to injured employee


Bradford Holding Company, Inc. of Beaumont
Order Number: DWC-3441
Date of Order:  7/28/2014
Action Taken:  Fined $17,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI records to TDI-DWC


California Insurance Company of Omaha, NE
Order Number: DWC-3392
Date of Order:  7/7/2014
Action Taken:  Fined $32,000
Violation:  Failed to timely provide services requested by policyholders; Failed to timely act on a properly completed medical bill; Failed to timely submit a accurate medical billing EDI records


Creative Risk Funding, Inc. of Plano
Order Number: DWC-3462
Date of Order:  7/30/2014
Action Taken:  Fined $20,000; Cease and desist from performing utilization review without certificate of registration
Violation:  Utilization review not conducted by licensed physician; Adjuster performing retrospective review of medical doctor visits not properly licensed; Issued medical necessity denials without allowing health care provider reasonable opportunity to discuss with medical doctor


Earle, Stephen Edward M.D. of San Antonio
Order Number: DWC-3469
Date of Order:  7/31/2014
Action Taken:  Removed from Texas workers' compensation system as a health practitioner for five years; Shall not receive direct or indirect remuneration from the Texas workers' compensation system for services performed after date of order
Violation:  Failed to document appropriate justification for intraoperative examinations and procedures performed on injured employees; Failed to document instability and/or need for procedures performed on injured employees


El Paso I.S.D. of El Paso
Order Number: DWC-3405
Date of Order:  7/10/2014
Action Taken:  Fined $6,600
Violation:  Failed to timely notify TDI-DWC of initial payment of income benefits to injured employee; Failed to accurately submit medical billing and payment data to TDI-DWC


General Casualty Company of Wisconsin of Sun Prairie, WI
Order Number: DWC-3423
Date of Order:  7/21/2014
Action Taken:  Fined $12,000
Violation:  Failed to submit accurate medical EDI records to TDI-DWC


Great American Alliance Insurance Company of Cincinnati, OH
Order Number: DWC-3389
Date of Order:  7/7/2014
Action Taken:  Fined $7,500
Violation:  Failed to comply with requirements for initial payment of income benefits to injured employees


Hartford Casualty Insurance Company of Hartford, CT
Order Number: DWC-3429
Date of Order:  7/21/2014
Action Taken:  Fined $1,000
Violation:  Failed to timely pay attorneys fees


Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-3424
Date of Order:  7/21/2014
Action Taken:  Fined $4,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to properly submit request for designated doctor examination


Injury Rehab Clinic of Houston
Order Number: DWC-3525
Date of Order:  7/21/2014
Action Taken:  Fined $2,000
Violation:  Failed to timely respond to request for a refund from an insurance carrier; Failed to timely comply with a TDI-DWC order


Morris, Jerry W., D.O. of Southlake
Order Number: DWC-3387
Date of Order:  7/7/2014
Action Taken:  Voluntarily surrendered and must never re-apply for designated doctor certification in Texas workers' compensation system
Violation:  Failed to timely respond to TDI-DWC request for letter of clarification; Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Neurosurgical Specialists of El Paso, P.L.L. of El Paso
Order Number: DWC-3431
Date of Order:  7/22/2014
Action Taken:  Fined $3,500
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Old Republic Insurance Company of Greensburg, PA
Order Number: DWC-3432
Date of Order:  7/22/2014
Action Taken:  Fined $12,500
Violation:  Failed to pay accurate benefits to injured employee; Failed to notify injured employee and TDI-DWC of actions on a claim; Failed to timely pay attorneys fees


Perez, Abimael M.D. of Corpus Christi
Order Number: DWC-3386
Date of Order:  7/7/2014
Action Taken:  Removed from Texas workers' compensation system as a health care provider
Violation:  Failed to document how treatment provided functional improvement to enhance ability of injured employee to return to work or retain employment; Failed to maintain efficient utilization of health care services to provide meaningful treatment to improve function


QBE Insurance Corporation of New York, NY
Order Number: DWC-3428
Date of Order:  7/21/2014
Action Taken:  Fined $47,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI records to TDI-DWC


Remirez, Carlos Manuel M.D. of El Paso
Order Number: DWC-3390
Date of Order:  7/7/2014
Action Taken:  Fined $3,000; Must complete medical training approved by TDI-DWC
Violation:  Failed to timely provide health care services by failing to incorporate active physical therapy in addition to medication for injured employee


Sanchez, Mario Alonzo D.O. of La Feria
Order Number: DWC-3400
Date of Order:  7/10/2014
Action Taken:  Fined $1,000; Must complete medical training approved by TDI-DWC
Violation:  Failed to practice medicine or provide health care in an acceptable manner consistent with public health, safety and welfare


Sierra Medical Center of Dallas
Order Number: DWC-3401
Date of Order:  7/10/2014
Action Taken:  Fined $1,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Southern Vanguard Insurance Company of Houston
Order Number: DWC-3418
Date of Order:  7/18/2014
Action Taken:  Fined $13,500
Violation:  Failed to submit accurate medical billing and payment data to TDI-DWC


Starr Comprehensive Solutions, Inc. of Houston
Order Number: DWC-3466
Date of Order:  7/30/2014
Action Taken:  Fined $25,000
Violation:  Personnel performing retrospective reviews not properly licensed; Issued medical necessity denials without allowing health care provider reasonable opportunity to discuss with medical doctor

The CompPAC Trust of Texas of Irving
Order Number: DWC-3426
Date of Order:  7/21/2014
Action Taken:  Fined $18,500
Violation:  Failed to submit accurate medical EDI records to TDI-DWC


The Mercantile Trust of Texas of Irving
Order Number: DWC-3427
Date of Order:  7/21/2014
Action Taken:  Fined $16,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI records to TDI-DWC


The Netherlands Insurance Company of Boston, MA
Order Number: DWC-3434
Date of Order:  7/25/2014
Action Taken:  Fined $24,000
Violation:  Failed to timely and accurately pay income benefits to injured employee; Failed to accurately pay death benefits; Failed to notify TDI-DWC of action taken on claims


Travelers Casualty Insurance Company of America of Hartford, CT
Order Number: DWC-3422
Date of Order:  7/21/2014
Action Taken:  Fined $10,000
Violation:  Failed to comply with requirements for income benefits payments and reporting


Warren, G. Emory, M.D. of Plano
Order Number: DWC-3417
Date of Order:  7/18/2014
Action Taken:  Fined $1,000
Violation:  Failed to timely provide medical records on an injured employee after receiving an order to produce them


West, David Adam D.O. of Franklin, TN
Order Number: DWC-3385
Date of Order:  7/7/2014
Action Taken:  Fined $500; Must provide certification of training completed
Violation:  Failed to timely notify TDI-DWC of disqualifying association after being selected as designated doctor of examination of injured employee


Wolinsky, Joel Scott M.D. of Sugar Land
Order Number: DWC-3421
Date of Order:  7/21/2014
Action Taken:  Fined $500
Violation:  Adopted and interpreted a medical test that had been improperly conducted


Boudreau, Daniel Alexander D.O. of Corpus Christi
Order Number: DWC-3344
Date of Order:  6/17/2014
Action Taken:  Fined $1,500
Violation:  Failed to maintain accurate records including injured employee's medical records for a designated doctor examination


Caldwell, Rodney Lynn M.D. of Dallas
Order Number: DWC-3370
Date of Order:  6/27/2014
Action Taken:  Fined $3,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records; Failed to timely respond to a request for clarification from TDI-DWC


Chavda, Deepak M.D. of North Richland Hills
Order Number: DWC-3365
Date of Order:  6/20/2014
Action Taken:  Removed from designated doctor list for five years; Must not certify MMI or IR as part of a referral from another health care practitioner
Violation:  Failed to provide sufficient documentation to justify maximum medical improvement (MMI) date and impairment rating (IR), and provided unnecessary tests as part of designated doctor examinations


Chin, Arthur Kelvin M.D. of Beeville
Order Number: DWC-3371
Date of Order:  6/27/2014
Action Taken:  Removed from workers' compensation system as health care provider
Violation:  Failed to appropriately document medical evaluations; Failed to document use of the MDA Guides to establish return-to-work goals


Houston I.S.D. of Houston
Order Number: DWC-3342
Date of Order:  6/17/2014
Action Taken:  Fined $4,968
Violation:  Failed to notify TDI-DWC and injured employee of actions taken on a claim; Failed to timely report initial payment of indemnity benefits; Failed to accurately submit medical EDI records to TDI-DWC


National Union Fire Insurance Company of Pittsburgh, PA of New York, NY
Order Number: DWC-3343
Date of Order:  6/17/2014
Action Taken:  Fined $4,491
Violation:  Failed to accurately submit medical bill and payment data


Samlowski, Eberhard R., M.D. of Cleburne
Order Number: DWC-3357
Date of Order:  6/20/2014
Action Taken:  Permanently denied designated doctor certification
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records; Failed to comply with commissioner rule or provision of Act


Tobola Electric of Halletsville
Order Number: DWC-3323
Date of Order:  6/2/2014
Action Taken:  Fined $1,000
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Ace Fire Underwriters Insurance Company of Philadelphia, PA
Order Number: DWC-3273
Date of Order:  5/13/2014
Action Taken:  Fined $14,615
Violation:  Failed to accurately submit medical bill data; Failed to timely pay or deny medical bills; Failed to accurately and/or timely submit reports to TDI-DWC


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-3292
Date of Order:  5/15/2014
Action Taken:  Fined $40,143
Violation:  Failed to timely pay benefits to injured employee; Failed to notify TDI-DWC and injured employee of actions taken on a claim; Failed to accurately submit medical bill and payment data; Failed to timely pay accrued benefits according to designated doctor's report


Castlepoint National Insurance Company of Chicago, IL
Order Number: DWC-3308
Date of Order:  5/20/2014
Action Taken:  Fined $16,029
Violation:  Failed to notify TDI-DWC and injured employee of actions taken on a claim; Failed to timely pay benefits to injured employee; Failed to accurately submit medical bill and payment data


Donna I.S.D. of Donna
Order Number: DWC-3295
Date of Order:  5/15/2014
Action Taken:   Fined $4,000
Violation:  Breached provision of benefits dispute agreement requiring timely compliance


Duclair, Cesar Pierre M.D. of Hurst
Order Number: DWC-3293
Date of Order:  5/15/2014
Action Taken:  Fined $2,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


East Texas Medical Center of Tyler
Order Number: DWC-3316
Date of Order:  5/30/2014
Action Taken:  Fined $4,000
Violation:  Failed to respond to request for a refund from insurance carrier


Federal Insurance Company of Warren, NJ
Order Number: DWC-3306
Date of Order:  5/20/2014
Action Taken:  Fined $3,000
Violation:  Failed to timely remit payment to independent review organization


Illinois National Insurance Company of New York, NY
Order Number: DWC-3318
Date of Order:  5/30/2014
Action Taken:  Fined $12,774
Violation:  Failed to submit accurate medical billing and payment data


Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-3307
Date of Order:  5/20/2014
Action Taken:  Fined $30,599
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely respond to request for reconsideration; Failed to timely pay benefits to injured employee


Lowes Home Centers, Inc. of Richardson
Order Number: DWC-3272
Date of Order:  5/13/2014
Action Taken:  Fined $40,000
Violation:  Failed to timely pay or deny medical bills; Failed to accurately and/or timely submit reports to TDI-DWC


Lumbermen's Underwriting Alliance of Boca Raton, FL
Order Number: DWC-3321
Date of Order:  5/30/2014
Action Taken:  Fined $4,779
Violation:  Failed to accurately submit medical bill and payment data


MasTec, Inc. of Coral Gables, FL
Order Number: DWC-3296
Date of Order:  5/15/2014
Action Taken:  Fined $15,310.
Violation:  Failed to timely pay or deny medical bills and to accurately and/or timely submit reports to TDI/DWC


New Hampshire Insurance Company of New York, NY
Order Number: DWC-3319
Date of Order:  5/30/2014
Action Taken:  Fined $29,981
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely notify TDI-DWC and injured employee of actions taken on a claim


Pacfic Employers Insurance Company of Philadelphia, PA
Order Number: DWC-3291
Date of Order:  5/15/2014
Action Taken:  Fined $11,360
Violation:  Failed to accurately submit medical bill and payment data


Segal, Andrew M.D. of Arlington
Order Number: DWC-3274
Date of Order:  5/13/2014
Action Taken:  Must not re-apply for designated doctor certification
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


St. Luke's Episcopal Health System of Houston
Order Number: DWC-3294
Date of Order:  5/15/2014
Action Taken:  Fined $3,000
Violation:  Improperly billed an injured employee for workers’ compensation medical services provided


Texas Political Subdivisions Joint Self Insurance Funds of Dallas
Order Number: DWC-3317
Date of Order:  5/30/2014
Action Taken:  Fined $11,000
Violation:  Failed to timely pay benefits to injured employee; Failed to notify TDI-DWC and injured employee of actions taken on a claim


The Insurance Company of the State of Pennsylvania of New York, NY
Order Number: DWC-3320
Date of Order:  5/30/2014
Action Taken:  Fined $8,397
Violation:  Failed to accurately submit medical bill and payment data


Wali, Gouher M.D. of Houston
Order Number: DWC-3305
Date of Order:  5/20/2014
Action Taken:  Must complete medical record documentation training; Must complete online medical education course
Violation:  Failed to document sufficient medical evidence and/or medical rationale to justify treatment of injured employees; Failed to document reasons for ordering work restrictions or for not establishing return to work plans for injured employees


Allmerica Financial Benefit Insurance Company of Worcester, MA
Order Number: DWC-3219
Date of Order:  4/21/2014
Action Taken:  Fined $2,140; Must conduct quarterly review of medical billing data submitted to TDI-DWC
Violation:  Failed to accurately submit medical bill and payment data


Amarillo I.S.D. of Amarillo
Order Number: DWC-3222
Date of Order:  4/23/2014
Action Taken:  Fined $606
Violation:  Failed to accurately submit medical bill and payment data


American Casualty Company of Reading, Pennsylvania of Chicago, IL
Order Number: DWC-3196
Date of Order:  4/9/2014
Action Taken:  Fined $7,312
Violation:  Failed to accurately submit medical bill and payment data


American Guarantee and Liability Insurance Company of Schaumburg, IL
Order Number: DWC-3201
Date of Order:  4/15/2014
Action Taken:  Fined $1,095
Violation:  Failed to accurately submit medical bill and payment data


American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-3202
Date of Order:  4/15/2014
Action Taken:  Fined $16,514
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely act on a properly completed medical bill


Cho, Sung-Joon M.D. of Kingsport, TN
Order Number: DWC-3200
Date of Order:  4/15/2014
Action Taken:  Fined $1,500
Violation:  Improperly refused an appointment to perform a subsequent designated doctor examination of injured employee


City of McAllen of McAllen
Order Number: DWC-3180
Date of Order:  4/9/2014
Action Taken:  Fined $1,804
Violation:  Failed to accurately submit medical bill and payment data


Clarendon National Insurance Company of New York City, NY
Order Number: DWC-3186
Date of Order:  4/9/2014
Action Taken:  Fined $4,053
Violation:  Failed to accurately submit medical bill and payment data


Commerce and Industry Insurance Company of New York City, NY
Order Number: DWC-3185
Date of Order:  4/9/2014
Action Taken:  Fined $5,800
Violation:  Failed to timely pay benefits to injured employee; Failed to notify TDI-DWC and injured employee of actions taken on a claim


Continental Casualty Company of Chicago, IL
Order Number: DWC-3195
Date of Order:  4/9/2014
Action Taken:  Fined $9,324
Violation:  Failed to timely pay properly completed medical bill received from health care provider; Failed to accurately submit medical bill and payment data


East Texas Educational Insurance Association of Tyler
Order Number: DWC-3226
Date of Order:  4/23/2014
Action Taken:  Fined $6,372
Violation:  Failed to accurately submit medical bill and payment data


Employers Compensation Insurance Company of Reno, NV
Order Number: DWC-3253
Date of Order:  4/29/2014
Action Taken:  Fined $1,125
Violation:  Failed to accurately submit medical bill and payment data


Fraser, Robert B., D.C. of McAllen
Order Number: DWC-3252
Date of Order:  4/29/2014
Action Taken:  Fined $3,500
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


GuideOne Elite Insurance Company of West Des Moines, IA
Order Number: DWC-3211
Date of Order:  4/17/2014
Action Taken:  Fined $4,042
Violation:  Failed to accurately submit medical bill and payment data


Hanover Lloyd's Insurance Company of Worcester, MA
Order Number: DWC-3223
Date of Order:  4/23/2014
Action Taken:  Fined $2,132; Must conduct quarterly review of medical billing data submitted to TDI-DWC
Violation:  Failed to accurately submit medical bill and payment data


Harris County of Houston
Order Number: DWC-3179
Date of Order:  4/9/2014
Action Taken:  Fined $1,985
Violation:  Failed to accurately submit medical bill and payment data

Hartford Casualty Insurance Company of Hartford, CT
Order Number: DWC-3191
Date of Order:  4/9/2014
Action Taken:  Fined $6,662
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely perform a mandatory on-site visit for policyholder


Hartford Fire Insurance Company of Hartford, CT
Order Number: DWC-3190
Date of Order:  4/9/2014
Action Taken:  Fined $3,618
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely pay benefits to injured employee; Failed to timely perform on-site visit for policyholder


Hartford Insurance Company of the Midwest of Hartford, CT
Order Number: DWC-3189
Date of Order:  4/9/2014
Action Taken:  Fined $11,460
Violation:  Failed to accurately submit medical bill and payment data; Failed to accurately pay benefits; Failed to accurately report claims data


Hartford Underwriters Insurance Company of Hartford, CT
Order Number: DWC-3188
Date of Order:  4/9/2014
Action Taken:  Fined $3,383
Violation:  Failed to accurately submit medical bill and payment data


LM Insurance Corporation of Boston, MA
Order Number: DWC-3224
Date of Order:  4/23/2014
Action Taken:  Fined $5,235
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately submit medical bill and payment data


LM Insurance Corporation of Boston, MA
Order Number: DWC-3251
Date of Order:  4/29/2014
Action Taken:  Fined $56,000
Violation:  Failed to comply with requirements for income benefits initial payments and reporting


Mahon-Deri, Brenda Marie M.D. of Fort Worth
Order Number: DWC-3225
Date of Order:  4/23/2014
Action Taken:  Fined $1,000
Violation:  Failed to maintain accurate records of designated doctor examination for required minimum time period


Massachusetts Bay Insurance Company of Worcester, MA
Order Number: DWC-3215
Date of Order:  4/21/2014
Action Taken:  Fined $2,089
Violation:  Failed to timely pay income benefits to injured employee;


National Fire Insurance Company of Hartford of Chicago, IL
Order Number: DWC-3194
Date of Order:  4/9/2014
Action Taken:  Fined $3,382
Violation:  Failed to accurately submit medical bill and payment data


OneBeacon Insurance Company, as successor in interest to Houston General Insurance Company of Canton, MA
Order Number: DWC-3227
Date of Order:  4/23/2014
Action Taken:  Fined $4,050
Violation:  Failed to accurately submit medical bill and payment data


Pacific Indemnity Company of Warren, NJ
Order Number: DWC-3213
Date of Order:  4/17/2014
Action Taken:  Fined $3,123
Violation:  Failed to timely pay income benefits to injured employee;


Peerless Insurance Company of Boston, MA
Order Number: DWC-3218
Date of Order:  4/21/2014
Action Taken:  Fined $15,500
Violation:  Failed to timely pay medical bill or to pay medical bill according to TDI-DWC Medical Fee Guidelines; Failed to accurately submit medical bill and payment data


Property & Casualty Insurance Company of Hartford of Hartford, CT
Order Number: DWC-3210
Date of Order:  4/17/2014
Action Taken:  Fined $3,104
Violation:  Failed to accurately submit medical bill and payment data


Safety National Casualty Corporation of St. Louis, MO
Order Number: DWC-3212
Date of Order:  4/17/2014
Action Taken:  Fined $32,109
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely pay income benefits to injured employee; Failed to timely pay benefits to injured employee per designated doctors report


Sam Kane Beef Processors, Inc. of Corpus Christi
Order Number: DWC-3169
Date of Order:  4/2/2014
Action Taken:  Fined $3,031
Violation:  Failed to accurately submit medical bill and payment data


Texas Mutual Insurance Company of Austin
Order Number: DWC-3216
Date of Order:  4/21/2014
Action Taken:  Fined $32,048; Must conduct quarterly review of medical billing data submitted to TDI-DWC
Violation:  Failed to accurately submit medical bill and payment data


The Hanover Insurance Company of Worcester, MA
Order Number: DWC-3220
Date of Order:  4/21/2014
Action Taken:  Fined $2,109; Must conduct quarterly review of medical billing data submitted to TDI-DWC
Violation:  Failed to accurately submit medical bill and payment data


The Phoenix Insurance Company of Hartford, CT
Order Number: DWC-3184
Date of Order:  4/9/2014
Action Taken:  Fined $10,628
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely act on request for reconsideration; Failed to timely pay benefits per designated doctors report


The Standard Fire Insurance Company of Hartford, CT
Order Number: DWC-3181
Date of Order:  4/9/2014
Action Taken:  Fined $9,795
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely act on a request for reconsideration; Failed to timely pay benefits per designated doctor report


The Travelers Indemnity Company of Hartford, CT
Order Number: DWC-3182
Date of Order:  4/9/2014
Action Taken:  Fined $19,442
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely pay benefits per designated doctors report


Thompson, Daniel O. III, M.D. of Keller
Order Number: DWC-3217
Date of Order:  4/21/2014
Action Taken:  Fined $3,600
Violation:  Improperly refused an appointment to perform a subsequent designated doctor examination of injured employee


Transportation Insurance Company of Chicago, IL
Order Number: DWC-3192
Date of Order:  4/9/2014
Action Taken:  Fined $4,593
Violation:  Failed to accurately submit medical bill and payment data


Travelers Property and Casualty Company of America of Hartford, CT
Order Number: DWC-3188
Date of Order:  4/9/2014
Action Taken:  Fined $17,012
Violation:  Failed to accurately submit medical EDI records to TDI-DWC


Travelers Property and Casualty Company of America of Hartford, CT
Order Number: DWC-3183
Date of Order:  4/9/2014
Action Taken:  Fined $17,012
Violation:  Failed to accurately and timely submit income benefit data; Failed to accurately submit medical bill and payment data; Failed to timely respond to a request for reconsideration


Twin City Fire Insurance Company of Hartford, CT
Order Number: DWC-3193
Date of Order:  4/9/2014
Action Taken:  Fined $5,079
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely pay benefits


Valley Forge Insurance Company of Chicago, IL
Order Number: DWC-3187
Date of Order:  4/9/2014
Action Taken:  Fined $2,055
Violation:  Failed to accurately submit medical bill and payment data


Ysleta I.S.D, of El Paso
Order Number: DWC-3228
Date of Order:  4/23/2014
Action Taken:  Fined $1,040
Violation:  Failed to accurately submit medical bill and payment data


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-3203
Date of Order:  4/15/2014
Action Taken:  Fined $47,735
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely act on a properly completed medical bill; Failed to timely pay benefits to injured employee; Failed to notify TDI-DWC and injured employee of action taken on a claim; Failed to timely report initial payment of indemnity benefits to TDI-DWC


Anderson, Mikel J. D.C. of El Paso
Order Number: DWC-3139
Date of Order:  3/21/2014
Action Taken:  Must complete medical documentation courses
Violation:  Administered improper or unreasonable treatment or services; Created treatment plan which did not enhance ability of injured employee to return to work; Failed to maintain efficient utilization of health care


Arrowood Indemnity Company of Charlotte, NC
Order Number: DWC-3056
Date of Order:  3/5/2014
Action Taken:  Fined $1,034
Violation:  Failed to accurately submit medical bill and payment data


Association Casualty Insurance Company of Austin
Order Number: DWC-3068
Date of Order:  3/5/2014
Action Taken:  Fined $16,500
Violation:  Failed to accurately and timely submit medical bill and payment data; Failed to timely pay, reduce, deny or to determine to audit a properly completed medical bill


Bancinsure Inc. of Oklahoma City, OK
Order Number: DWC-3096
Date of Order:  3/11/2014
Action Taken:  Fined $4,125
Violation:  Failed to accurately submit medical bill and payment data


Benchmark Insurance Company of Wayzata, MN
Order Number: DWC-3158
Date of Order:  3/28/2014
Action Taken:  Fined $7,048
Violation:  Failed to accurately submit medical bill and payment data


Bituminous Casualty Corporation of Rock Island, IL
Order Number: DWC-3131
Date of Order:  3/19/2014
Action Taken:  Fined $6,591
Violation:  Failed to accurately submit medical bill and payment data


Bituminous Fire and Marine Insurance Company of Rock Island, IL
Order Number: DWC-3130
Date of Order:  3/19/2014
Action Taken:  Fined $6,373
Violation:  Failed to accurately submit medical bill and payment data


Central Mutual Insurance Company of Van Wert, OH
Order Number: DWC-3058
Date of Order:  3/5/2014
Action Taken:  Fined $4,038
Violation:  Failed to accurately submit medical bill and payment data


Centre Insurance Company of New York City, NY
Order Number: DWC-3167
Date of Order:  3/28/2014
Action Taken:  Fined $4,106
Violation:  Failed to accurately submit medical bill and payment data


Chubb Indemnity Company of West Lake Hills
Order Number: DWC-3055
Date of Order:  3/5/2014
Action Taken:  Fined $5,725.30
Violation:  Failed to accurately submit medical bill and payment data


Church Mutual Insurance Company of Merrill, WI
Order Number: DWC-3117
Date of Order:  3/19/2014
Action Taken:  Fined $407
Violation:  Failed to accurately submit medical bill and payment data


City of El Paso of El Paso
Order Number: DWC-3166
Date of Order:  3/28/2014
Action Taken:  Fined $2,163
Violation:  Failed to accurately submit medical bill and payment data


City of Lewisville of Lewisville
Order Number: DWC-3163
Date of Order:  3/28/2014
Action Taken:  Fined $19,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to accurately submit medical bill and payment data; Failed to timely notify TDI-DWC of request for independent review


Companion Property & Casualty of Fort Worth
Order Number: DWC-3164
Date of Order:  3/28/2014
Action Taken:  Fined $3,233
Violation:  Failed to accurately submit medical bill and payment data


Costello, James H., D.C. of Beaumont
Order Number: DWC-3081
Date of Order:  3/11/2014
Action Taken:  Must complete complete medical record and documentation training and medical disability guide training
Violation:  Utilized a treatment plan for injured employee that included unreasonable, unnecessary or unjustified number of procedures per office visit; Provided treatment plan that did not promote recovery or allow return to work


Dallas Area Rapid Transit of Dallas
Order Number: DWC-3157
Date of Order:  3/28/2014
Action Taken:  Fined $1,380
Violation:  Failed to accurately submit medical bill and payment data


Dallas County of Dallas
Order Number: DWC-3099
Date of Order:  3/12/2014
Action Taken:  Fined $1,807
Violation:  Failed to accurately submit medical bill and payment data


Dallas I.S.D. of Dallas
Order Number: DWC-3165
Date of Order:  3/28/2014
Action Taken:  Fined $13,103
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely pay income benefits to injured employee; Failed to timely notify TDI-DWC and injured employee of actions taken on a claim; Failed to timely report initial payment of income benefits


Discover Property and Casualty Insurance Company of Hartford, CT
Order Number: DWC-3115
Date of Order:  3/19/2014
Action Taken:  Fined $4,139
Violation:  Failed to accurately submit medical bill and payment data


Dolgencorp of Texas, Inc. of Austin
Order Number: DWC-3159
Date of Order:  3/28/2014
Action Taken:  Fined $6,000
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely act on a properly completed medical bill


E.I. du Pont deNemours and Company of Wilmington, DE
Order Number: DWC-3119
Date of Order:  3/19/2014
Action Taken:  Fined $10,000
Violation:  Failed to accurately submit medical bill and payment data


El Paso County of El Paso
Order Number: DWC-3132
Date of Order:  3/19/2014
Action Taken:  Fined $4,812
Violation:  Failed to accurately submit medical bill and payment data

Employers Assurance Company of Reno, NV
Order Number: DWC-3094
Date of Order:  3/11/2014
Action Taken:  Fined $5,626
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely pay income benefits to injured employee; Failed to timely report initial payment of indemnity benefits to TDI-DWC


Employers Preferred Insurance Company of Reno, NV
Order Number: DWC-3080
Date of Order:  3/11/2014
Action Taken:  Fined $626
Violation:  Failed to accurately submit medical bill and payment data


Fairmont Insurance Company of Manchester, NH
Order Number: DWC-3154
Date of Order:  3/28/2014
Action Taken:  Fined $7,078
Violation:  Failed to accurately submit medical bill and payment data


Farmers Insurance Exchange of Austin
Order Number: DWC-3150
Date of Order:  3/28/2014
Action Taken:  $4,066
Violation:  Failed to accurately submit medical bill and payment data


Farmington Casualty Company of Hartford, CT
Order Number: DWC-3114
Date of Order:  3/19/2014
Action Taken:  Fined $1,184
Violation:  Failed to accurately submit medical bill and payment data


Federal Insurance Company of Warren, NJ
Order Number: DWC-3061
Date of Order:  3/5/2014
Action Taken:  Fined $37,597
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely process and take final action on a properly completed medical bill; Failed to timely report initial payment of indemnity benefits to TDI-DWC


FedEx Ground Package System Inc. of Pittsburgh, PA
Order Number: DWC-3064
Date of Order:  3/5/2014
Action Taken:  Fined $813
Violation:  Failed to accurately submit medical bill and payment data


Fidelity and Guaranty Insurance Company of St. Paul, MN
Order Number: DWC-3123
Date of Order:  3/19/2014
Action Taken:  Fined $11,744
Violation:  Failed to accurately submit medical bill and payment data


Fireman's Fund Insurance Company of Novato, CA
Order Number: DWC-3134
Date of Order:  3/19/2014
Action Taken:  Fined $3,262
Violation:  Failed to accurately submit medical bill and payment data


Fort Bend County of Richmond
Order Number: DWC-3140
Date of Order:  3/21/2014
Action Taken:  Fined $6,000
Violation:  Failed to accurately submit medical bill and payment data


Freestone Insurance Company of Dallas
Order Number: DWC-3161
Date of Order:  3/28/2014
Action Taken:  Fined $8,619
Violation:  Failed to accurately submit medical bill and payment data


Frisco I.S.D. of Frisco
Order Number: DWC-3069
Date of Order:  3/5/2014
Action Taken:  Fined $1,040
Violation:  Failed to accurately submit medical bill and payment data


Great Midwest Insurance Company of Houston
Order Number: DWC-3124
Date of Order:  3/19/2014
Action Taken:  Fined $4,280
Violation:  Failed to accurately submit medical bill and payment data


Great Northern Insurance Company of Warren, NJ
Order Number: DWC-3053
Date of Order:  3/5/2014
Action Taken:  Fined $4,286.80
Violation:  Failed to accurately submit medical bill and payment data


Helsten, Robert Allen M.D. of Denton
Order Number: DWC-3082
Date of Order:  3/11/2014
Action Taken:  Fined $1,000; Must complete one-day designated doctor workshop
Violation:  Medical records did not support scope of compensable injury; Failed to correctly apply AMA guidelines to assign impairment rating


Mid-Century Insurance Company of Austin
Order Number: DWC-3151
Date of Order:  3/28/2014
Action Taken:  Fined $3,532
Violation:  Failed to accurately submit medical bill and payment data


Middlesex Insurance Company of Stevens Point, WI
Order Number: DWC-3133
Date of Order:  3/19/2014
Action Taken:  Fined $783
Violation:  Failed to accurately submit medical bill and payment data


Midwest Employers Casualty Company of Chesterfield, MO
Order Number: DWC-3095
Date of Order:  3/11/2014
Action Taken:  Fined $3,469
Violation:  Failed to accurately submit medical bill and payment data


Mitsui Sumitomo Insurance Company of America of Warren, NJ
Order Number: DWC-3087
Date of Order:  3/11/2014
Action Taken:  Fined $5,977
Violation:  Failed to accurately submit medical bill and payment data


Mitsui Sumitomo Insurance USA, Inc. of Warren, NJ
Order Number: DWC-3086
Date of Order:  3/11/2014
Action Taken:  Fined $4,188
Violation:  Failed to accurately submit medical bill and payment data


National Surety Corporation of Novato, CA
Order Number: DWC-3136
Date of Order:  3/19/2014
Action Taken:  Fined $1,292
Violation:  Failed to accurately submit medical bill and payment data


Nationwide Agribusiness Insurance Company of Des Moines, IA
Order Number: DWC-3160
Date of Order:  3/28/2014
Action Taken:  Fined $1,164
Violation:  Failed to accurately submit medical bill and payment data


Old Republic General Insurance Corporation of Atlanta, GA
Order Number: DWC-3063
Date of Order:  3/5/2014
Action Taken:  Fined $1,316
Violation:  Failed to accurately submit medical bill and payment data


Old Republic Insurance Company of Greensburg, PA
Order Number: DWC-3111
Date of Order:  3/19/2014
Action Taken:  Fined $15,905
Violation:  Failed to accurately submit medical bill and payment data; Suspended income benefits for injured employee without providing explanation


Panzarella, Robert L., M.D. of Kingwood
Order Number: DWC-3113
Date of Order:  3/19/2014
Action Taken:  Fined $3,000; Must remove designated doctor examination sites from TDI-DWC profile
Violation:  Performed designated doctor examinations in facilities not used or properly equipped for medical examinations


Pharmacists Mutual Insurance Company of Algona, IA
Order Number: DWC-3054
Date of Order:  3/5/2014
Action Taken:  Fined $4,090
Violation:  Failed to accurately submit medical bill and payment data


Prasad, A.R.S., M.D. of Houston
Order Number: DWC-3065
Date of Order:  3/5/2014
Action Taken:  Fined $1,000; Must complete 8 hours continuing medical education
Violation:  Failed to practice medicine or provide health care in acceptable manner consistent with public health, safety and welfare; Failed to document an injury to justify ongoing treatments and medications


Protective Insurance Company of Carmel, IN
Order Number: DWC-3059
Date of Order:  3/5/2014
Action Taken:  Fined $10,965
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely pay or deny medical bills and to accurately and/or timely submit reports to TDI-DWC


Seabright Insurance Company of Seattle, WA
Order Number: DWC-3135
Date of Order:  3/19/2014
Action Taken:  Fined $39,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to timely and accurately submit medical bill and payment data


Security National Insurance Company of Dallas
Order Number: DWC-3079
Date of Order:  3/11/2014
Action Taken:  Fined $3,097
Violation:  Failed to accurately submit medical bill and payment data


Sentry Insurance A Mutual Company of Stevens Point, WI
Order Number: DWC-3129
Date of Order:  3/19/2014
Action Taken:  Fined $17,731
Violation:  Failed to timely pay income benefits to injured employee; Failed to notify TDI-DWC of actions taken on a claim; Failed to accurately submit medical bill and payment data


Service Lloyds Insurance Company of Austin
Order Number: DWC-3060
Date of Order:  3/5/2014
Action Taken:  Fined $10,783
Violation:  Failed to accurately submit medical bill and payment data


Sompo Japan Insurance Company of America of Charlotte, NC
Order Number: DWC-3062
Date of Order:  3/5/2014
Action Taken:  Fined $1,220
Violation:  Failed to accurately submit medical bill and payment data


Southern Insurance Company of Dallas
Order Number: DWC-3125
Date of Order:  3/19/2014
Action Taken:  Fined $1,183
Violation:  Failed to accurately submit medical bill and payment data


Springfield Insurance Company of Covina, CA
Order Number: DWC-3137
Date of Order:  3/19/2014
Action Taken:  Fined $4,113
Violation:  Failed to accurately submit medical bill and payment data


St. Paul Fire and Marine Insurance Company of Valrico, FL
Order Number: DWC-3122
Date of Order:  3/19/2014
Action Taken:  Fined $2,343
Violation:  Failed to accurately submit medical bill and payment data


St. Paul Mercury Insurance Company of Hartford, CT
Order Number: DWC-3127
Date of Order:  3/19/2014
Action Taken:  Fined $704
Violation:  Failed to accurately submit medical bill and payment data


Star Insurance Company of Southfield, MI
Order Number: DWC-3152
Date of Order:  3/28/2014
Action Taken:  Fined $1,423
Violation:  Failed to accurately submit medical bill and payment data


State Farm Fire and Casualty Company of Bloomington, IL
Order Number: DWC-3097
Date of Order:  3/11/2014
Action Taken:  Fined $4,500
Violation:  Failed to timely pay or deny medical bills and to accurately and/or timely submit reports to TDI-DWC


Stephens, Joseph W., III, M.D. of Arlington, TX
Order Number: DWC-3162
Date of Order:  3/28/2014
Action Taken:  Fined $1,000
Violation:  Failed to maintain accurate records of designated doctor examination for required length of time


Tarrant County Hospital District of Fort Worth
Order Number: DWC-3098
Date of Order:  3/11/2014
Action Taken:  Fined $21,000
Violation:  Failed to accurately and timely submit medical bill and payment data; Failed to timely pay, reduce, deny or determine to audit a properly completed medical bill


Texas Builders Insurance Company of Austin
Order Number: DWC-3057
Date of Order:  3/5/2014
Action Taken:  Fined $3,866
Violation:  Failed to accurately submit medical bill and payment data


Textron, Inc. of Providence, RI
Order Number: DWC-3066
Date of Order:  3/5/2014
Action Taken:  Fined $1,370
Violation:  Failed to accurately submit medical bill and payment data


The American Insurance Company of Novato, CA
Order Number: DWC-3126
Date of Order:  3/19/2014
Action Taken:  Fined $1,589
Violation:  Failed to accurately submit medical bill and payment data


The Charter Oak Fire Insurance Company of Hartford, CT
Order Number: DWC-3120
Date of Order:  3/19/2014
Action Taken:  Fined $1,561
Violation:  Failed to accurately submit medical bill and payment data


The Travelers Indemnity Company of America of Hartford, CT
Order Number: DWC-3112
Date of Order:  3/19/2014
Action Taken:  Fined $2,638
Violation:  Failed to accurately submit medical bill and payment data; Failed to take final action on a medical bill within 45 days


TIG Insurance Company of Manchester, NH
Order Number: DWC-3155
Date of Order:  3/28/2014
Action Taken:  Fined $7,007
Violation:  Failed to accurately submit medical bill and payment data


TIG Insurance Company of Texas of Irving
Order Number: DWC-3156
Date of Order:  3/28/2014
Action Taken:  Fined $7,040
Violation:  Failed to accurately submit medical bill and payment data


Travelers Casualty and Surety Company of Hartford, CT
Order Number: DWC-3128
Date of Order:  3/19/2014
Action Taken:  Fined $1,369
Violation:  Failed to accurately submit medical bill and payment data


Travelers Casualty Insurance Company of America of Hanford, CT
Order Number: DWC-3121
Date of Order:  3/19/2014
Action Taken:  Fined $832
Violation:  Failed to accurately submit medical bill and payment data

Trinity Universal Insurance Company of Jacksonville, FL
Order Number: DWC-3085
Date of Order:  3/11/2014
Action Taken:  Fined $3,076
Violation:  Failed to accurately submit medical bill and payment data


Truck Insurance Exchange of Austin
Order Number: DWC-3153
Date of Order:  3/28/2014
Action Taken:  Fined $4,712
Violation:  Failed to accurately submit medical bill and payment data


United States Fidelity and Guaranty Company of Hartford, CT
Order Number: DWC-3116
Date of Order:  3/19/2014
Action Taken:  Fined $13,307
Violation:  Failed to accurately submit medical bill and payment data


United States Fire Insurance Company of Morristown, NJ
Order Number: DWC-3067
Date of Order:  3/5/2014
Action Taken:  Fined $2,149
Violation:  Failed to accurately submit medical bill and payment data


VIA Metropolitan Transit of San Antonio
Order Number: DWC-3100
Date of Order:  3/12/2014
Action Taken:  Fined $1,587
Violation:  Failed to accurately submit medical bill and payment data


Winn Dixie Louisiana Inc. of Jacksonville, FL
Order Number: DWC-3118
Date of Order:  3/19/2014
Action Taken:  Fined $4,121
Violation:  Failed to accurately submit medical bill and payment data


XL Specialty Insurance Company of Stamford, CT
Order Number: DWC-3088
Date of Order:  3/11/2014
Action Taken:  Fined $4,151
Violation:  Failed to accurately submit medical bill and payment data


ACIG Insurance Company of Dallas, TX
Order Number: DWC-3027
Date of Order:  2/21/2014
Action Taken:  Fined $4,928
Violation:  Submitted inaccurate medical billing data to TDI-DWC


Alaska National Insurance Company of Anchorage, AK
Order Number: DWC-3015
Date of Order:  2/14/2014
Action Taken:  Fined $5,110
Violation:  Submitted inaccurate medical bill data to TDI-DWC


America First Lloyd's Insurance Company of Richardson
Order Number: DWC-3030
Date of Order:  2/24/2014
Action Taken:  Fined $2,683
Violation:  Submitted inaccurate medical billing data to TDI-DWC


City of San Antonio of San Antonio
Order Number: DWC-3029
Date of Order:  2/21/2014
Action Taken:  Fined $3,964
Violation:  Submitted inaccurate medical billing data to TDI-DWC


Dilger, J. Thomas, Jr., M.D. of Spring
Order Number: DWC-3013
Date of Order:  2/14/2014
Action Taken:  Must not re-apply for designated doctor certification in the Texas workers' compensation system
Violation:  Assigned impairment ratings that failed to comply with medical guidelines; Failed to document objective medical evidence and/or an analysis of evidence to support conclusions on designated doctor questions; Failed to perform adequate examination; Failed to obtain complete set of medical records


Hyatt Corp. of Chicago, IL
Order Number: DWC-3018
Date of Order:  2/14/2014
Action Taken:  Fined $880.50
Violation:  Submitted inaccurate medical bill data to TDI-DWC


Marioni, Luis, D.C. of El Paso
Order Number: DWC-2999
Date of Order:  2/12/2014
Action Taken:  Fined $2,500; Must complete online medical education course within 180 days; Must attend medical record documentation course; Must submit documentation of continuing medical education completed for medical license renewal
Violation:  Administered improper, unreasonable or medically unnecessary treatment and services; Failed to document rationale for not following medical guidelines; Failed to comply with commissioner rule


Meridian Security Insurance Company of Indianapolis, IN
Order Number: DWC-3026
Date of Order:  2/21/2014
Action Taken:  Fined $4,147
Violation:  Submitted inaccurate medical billing data to TDI-DWC


Mesquite I.S.D. of Mesquite
Order Number: DWC-3017
Date of Order:  2/14/2014
Action Taken:  Fined $1,172
Violation:  Submitted inaccurate medical bill data to TDI-DWC


National American Insurance Company of Chandler, OK
Order Number: DWC-3014
Date of Order:  2/14/2014
Action Taken:  Fined $5,122
Violation:  Submitted inaccurate medical bill data to TDI-DWC


Netherlands Insurance Company of Boston, MA
Order Number: DWC-3028
Date of Order:  2/21/2014
Action Taken:  Fined $6,801
Violation:  Submitted inaccurate medical billing data to TDI-DWC


OneBeacon Insurance Company of Canton, MA
Order Number: DWC-3025
Date of Order:  2/20/2014
Action Taken:  Fined $1,093
Violation:  Submitted inaccurate medical bill data to TDI-DWC


Praetorian Insurance Company of New York, NY
Order Number: DWC-3019
Date of Order:  2/14/2014
Action Taken:  Fined $20,000
Violation:  Failed to timely pay medical bill; Failed to timely submit medical bill and payment data to TDI-DWC; Failed to accurately submit medical EDI records to TDI-DWC


T.H.E. Insurance Company of Treasure Island, FL
Order Number: DWC-3016
Date of Order:  2/14/2014
Action Taken:  Fined $4,146
Violation:  Submitted inaccurate medical bill data to TDI-DWC


TASB Risk Management Fund of Austin
Order Number: DWC-3032
Date of Order:  2/25/2014
Action Taken:  Fined $16,124; Must conduct quarterly self audits during calendar year 2014 and submit first report to TDI-DWC by March 31, 2014
Violation:  Submitted inaccurate medical billing data to TDI-DWC


Zenith Insurance Company of Austin
Order Number: DWC-3012
Date of Order:  2/14/2014
Action Taken:  Fined $3,827
Violation:  Submitted inaccurate medical bill data to TDI-DWC


Companion Property and Casualty Insurance Company of Columbia, SC
Order Number: DWC-3494
Date of Order:  8/20/2014
Action Taken:  Fined $28,500
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate EDI records to TDI_DWC


Meyer, Ralph C., D.C. of Garland
Order Number: DWC-2987
Date of Order:  1/31/2014
Action Taken:  Fined $2,500
Violation:  Failed to maintain efficient utilization of health care by ordering unnecessary diagnostic testing, prescribing excessive amounts of physical therapy and scheduling unnecessary office visits


Myles, Robert Tytan, M.D. of Bedford
Order Number: DWC-2985
Date of Order:  1/31/2014
Action Taken:  Permanently removed from Texas workers' compensation system as a health care provider
Violation:  Performed two surgical procedures that were unreasonable and medically unnecessary because procedures not justified by sufficient medical evidence


Pennsylvania Manufacturers' Association Insurance Company of Blue Bell, PA
Order Number: DWC-2986
Date of Order:  1/31/2014
Action Taken:  Fined $1,288
Violation:  Submitted inaccurate medical bill data to TDI-DWC


Texas Mutual Insurance Company of Austin
Order Number: DWC-2949
Date of Order:  1/10/2014
Action Taken:  Fined $2,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to pay correct amount of income benefits to injured employee; Failed to timely notify TDI-DWC of payment change


Travis County of Austin
Order Number: DWC-2984
Date of Order:  1/31/2014
Action Taken:  Fined $734
Violation:  Submitted inaccurate medical bill data to TDI-DWC


2013


Alvarado, Hilario III, M.D. of San Antonio
Order Number: DWC-2903
Date of Order:  12/16/2013
Action Taken:  Fined $2,000
Violation:  Refused to accept a TDI-DWC appointment to perform a subsequent designated doctor examination on one injured employee


Gonzales, Mary Anastasia M.D. of Austin
Order Number: DWC-2901
Date of Order:  12/16/2014
Action Taken:  Fined $500; Must complete one-day designated doctor workshop
Violation:  Failed to correctly apply AMA Guides; Failed to document adequately in one designated doctor examination


Jarolimek, Lubor Jan M.D. of Houston
Order Number: DWC-2902
Date of Order:  12/16/2013
Action Taken:  Fined $1,000; Must complete a one-day designated doctor workshop
Violation:  Failed to correctly apply the AMA Guides; ordered an unnecessary medical test; Failed to document an adequate narrative report


Sanders, Mark Seltzer M.D. of Houston
Order Number: DWC-2900
Date of Order:  12/16/2014
Action Taken:  Permanently surrendered designated doctor certification and certification to assign maximum medical improvement and impairment ratings
Violation:  Failed to comply with a TDI-DWC Order for Production; Ordered an unnecessary medical test as part of a designated doctor examination


Smith, Stephen L., D.O. of Fredericksburg
Order Number: DWC-2910
Date of Order:  12/17/2013
Action Taken:  Must complete designated doctor training and pass the certification test in no more than three attempts; upon timely passing the designated doctor certification test, must participate in medical quality review monitoring review and pay $15,000 fine
Violation:  Failed to comply with TDI-DWC decisions and orders; Designated doctor assessments of injured employees overturned by contested case hearings; Used inflammatory and inappropriate language in his designated doctor reports for injured employees; Designated doctor examination's diagnoses, evaluations, and impairment ratings were substantially different from those that Commissioner finds to be fair and reasonable; Did not address the issues as ordered by TDI-DWC in the form and manner prescribed; Misrepresented or omitted pertinent facts in his medical evaluations and narrative reports; Submitted a charge for health care that was not furnished; Failed to perform a complete physical examination for purpose of determining MMI and IR; Failed to timely file and/or accurately complete TDI-DWC forms, reports or records.


Austin Total Healthcare of Austin
Order Number: DWC-2834
Date of Order:  11/5/2013
Action Taken:  Fined $3,000
Violation:  Failed to respond to request for refund from an insurance carrier; Failed to timely comply with a TDI-DWC order


Deiter, Cary Thomas D.C. of El Paso
Order Number: DWC-2848
Date of Order:  11/19/2013
Action Taken:  Fined $3,000; Must complete continuing education hours approved by TDI-DWC
Violation:  Administered improper, unreasonable or medically unnecessary treatment or services


Farmers Insurance Exchange of Los Angeles, CA
Order Number: DWC-2845
Date of Order:  11/8/2013
Action Taken:  Fined $1,000
Violation:  Failed to provide on-site visit or other appropriate services to three policyholders with a premium greater than $25,000 within a 12 month period


Griffith, David M., D.C. of San Antonio
Order Number: DWC-2835
Date of Order:  11/5/2013
Action Taken:  Fined $3,000; Must complete continuing education hours approved by TDI-DWC
Violation:  Failed to document subjective and objective functional improvement gains for injured worker


Kaufman, James K., M.D. of Fort Worth
Order Number: DWC-2865
Date of Order:  11/22/2013
Action Taken:  Removed from the Texas Workers' Compensation system as a health care practitioner
Violation:  Performed surgeries without demonstratable pathology or benefit to be derived from surgery


Kordestani, Rouzebeh K., M.D. of Amarillo
Order Number: DWC-2863
Date of Order:  11/22/2013
Action Taken:  Voluntary and permanent surrender of designated doctor certification and certification to assign maximum medical improvement dates and impairment ratings
Violation:  Failed to obtain TDI-DWC approval prior to changing location of a designated doctor examination; Failed to follow proper procedure to reschedule a designated doctor exam; Failed to comply with a DWC Order for Production; Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Plano Independent School District of Plano
Order Number: DWC-2864
Date of Order:  11/22/2013
Action Taken:  Fined $2,500
Violation:  Improperly withheld funds from injured employee's salary


Stephenson, Jackie Dean M.D. of San Antonio
Order Number: DWC-2850
Date of Order:  11/19/2013
Action Taken:  Removed from Texas Workers' Compensation system as a health care practitioner as of December 31, 2013
Violation:  Failed to provide health care reasonably required by nature of injury and needed to promote recovery; Failed to maintain an efficient utilization of health care through extensive and prolonged treatment without adequate documentation


Strickland, Mark Joseph, D.C. of Copeville
Order Number: DWC-2866
Date of Order:  11/22/2013
Action Taken:  Fined $2,500
Violation:  Failed to maintain efficient utilization of medical care through documentation and record keeping; Provided improper, unreasonable or medically unnecessary treatment or services


Alexander, Richard A., D.C. of San Antonio
Order Number: DWC-2827
Date of Order:  10/28/2013
Action Taken:  Must complete continuing education hours approved by TDI-DWC
Violation:  Administered improper or unreasonable treatment or services -- treatment plan did not enhance ability of injured employee to return to work


Cole, George M., D.O. of Dallas
Order Number: DWC-2826
Date of Order:  10/28/2013
Action Taken:  Fined $500; must complete designated doctor core competency workshop within 90 days
Violation:  Failed to include required information in a designated doctor examination narrative report


Jensen, Jack Edward M.D. of Houston
Order Number: DWC-2796
Date of Order:  10/3/2013
Action Taken:  Fined $2,000
Violation:  Failed to timely respond to two requests for letters of clarification


Texas Automobile Dealers Self Insurers Group of Austin
Order Number: DWC-2828
Date of Order:  10/28/2013
Action Taken:  Fined $1,000
Violation:  Failed to timely pay benefits to injured employee


The Insurance Company of the State of Pennsylvania of New York, NY
Order Number: DWC-2825
Date of Order:  10/28/2013
Action Taken:  Fined $2,200
Violation:  Submitted inaccurate medical EDI records; Failed to timely pay and ordered benefit advance; failed to timely notify TDI-DWC of change in benefit type, termination of income benefits


Williams, Clyde Marion M.D. of Amarillo
Order Number: DWC-2795
Date of Order:  10/3/2013
Action Taken:  Nunc Pro Tunc Order
Violation:  Corrects two clerical errors in Order No. 2105 regarding DWC forms filed and reduces fine


Adair Grain Company of West

Order Number: DWC-2789
Date of Order:  9/30/2013
Order Final In:   September
Action Taken:  Fined $500
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


American Hallmark Insurance Company of Texas of Austin
Order Number: DWC-2736
Date of Order:  9/5/2013
Order Final In:   September
Action Taken:  Fined $6,000
Violation:  Failed to accurately submit medical records via electronic data interchange


Chadadeh, Hassan M.D. of Houston
Order Number: DWC-2735
Date of Order:  9/5/2013
Order Final In:   September
Action Taken:  Fined $5,000; Must complete physician assessment and clinical education course (PACE)
Violation:  Failed to sufficiently document justification for prescriptions


Dallas National Insurance Company of Dallas
Order Number: DWC-2767
Date of Order:  9/17/2013
Order Final In:   September
Action Taken:  Fined $12,500
Violation:  Failed to timely pay income benefits and accrued interest to an injured employee according to a contested case hearing decision and order


MedRisk, Inc. of King of Prussia, PA
Order Number: DWC-2746
Date of Order:  9/12/2013
Order Final In:   September
Action Taken:  Fined $17,500
Violation:  Failed to remit full amount reimbursed by the insurance carrier to the health care provider


Pacific Indemnity Company of Warren, NJ
Order Number: DWC-2766
Date of Order:  9/17/2013
Order Final In:   September
Action Taken:  Fined $17,500
Violation:  Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange; Failed to timely pay income benefits to injured employee


Retailers Casualty Insurance Company of Alexandria, LA
Order Number: DWC-2748
Date of Order:  9/12/2013
Order Final In:   September
Action Taken:  Fined $9,000
Violation:  Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange


Tarrant County College District of Fort Worth
Order Number: DWC-2747
Date of Order:  9/12/2013
Order Final In:   September
Action Taken:  Fined $15,000
Violation:  Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange


Vigilant Insurance Company of Warren, NJ
Order Number: DWC-2768
Date of Order:  9/18/2013
Order Final In:   September
Action Taken:  Fined $6,500
Violation:  Failed to submit accurate medical bill data to TDI-DWC


AAA Cooper Transportation of Dothan, AL
Order Number: DWC-2730
Date of Order:  8/30/2013
Order Final In:   August
Action Taken:  Fined $5,000
Violation:  Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange


ACIG Insurance Company of Dallas
Order Number: DWC-2682
Date of Order:  8/2/2013
Order Final In:   August
Action Taken:  Fined $10,000
Violation:  Failed to timely pay income benefits to injured employee


Bangale, Anil T., M.D. of Fort Worth
Order Number: DWC-2680
Date of Order:  8/2/2013
Order Final In:   August
Action Taken:  Fined $5,000
Violation:  Quality of health care provided not in compliance with statutory requirements; Failed to report a disciplinary action on Designated Doctor application


Burke, Douglas William D.C. of San Antonio
Order Number: DWC-2709
Date of Order:  8/23/2013
Order Final In:   August
Action Taken:  Fined $5,000; Must complete continuing education course on following medical guidelines
Violation:  Provided treatment not in accord with applicable treatment guidelines and not within the standard of care


East Texas Educational Insurance Association of Tyler
Order Number: DWC-2710
Date of Order:  8/23/2013
Order Final In:   August
Action Taken:  Fined $2,000
Violation:  Failed to timely report medical electronic data interchange (EDI) records to TDI-DWC


Ebeade, Samir S., M.D. of Orange
Order Number: DWC-2720
Date of Order:  8/26/2013
Order Final In:   August
Action Taken:  Must cease designated doctor examinations at a specific location and must request the location for examinations be deleted from TDI-DWC system
Violation:  Failed to use a properly equipped medical facility for designated doctor examinations


El Paso County Hospital District of El Paso
Order Number: DWC-2708
Date of Order:  8/23/2013
Order Final In:   August
Action Taken:  Fined $11,000
Violation:  Failed to accurately and timely submit electronic data interchange (EDI) records to TDI-DWC


Florists' Mutual Insurance Company of Edwardsville, IL
Order Number: DWC-2707
Date of Order:  8/23/1013
Order Final In:   August
Action Taken:  Fined $2,500
Violation:  Failed to accurately submit medical bill and payment data


Harlandale Independent School District of San Antonio
Order Number: DWC-2724
Date of Order:  8/28/2013
Order Final In:   August
Action Taken:  Fined $4,000
Violation:  Failed to timely comply with a TDI-DWC order


Kestler, Bryan Claude D.C. of Port Lavaca
Order Number: DWC-2718
Date of Order:  8/26/2013
Order Final In:   August
Action Taken:  Fined $1,000
Violation:  Failed to comply with Texas Workers' Compensation Act


ORR, Inc. of Texarkana
Order Number: DWC-2681
Date of Order:  8/2/2013
Order Final In:   August
Action Taken:  Fined $1,000
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


West Rest Haven, Inc. of West
Order Number: DWC-2725
Date of Order:  8/28/2013
Order Final In:   August
Action Taken:  Fined $1,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports, or records


Amerisure Partners Insurance Company of Farmington Hills, MI
Order Number: DWC-2651
Date of Order:  7/17/2013
Order Final In:   July
Action Taken:  Fined $13,500
Violation:  Failed to accurately submit medical bill and payment data to TDI-DWC


Bates, Aaron M.D. of Fleming Island, FL
Order Number: DWC-2649
Date of Order:  7/17/2013
Order Final In:   July
Action Taken:  Permanently cease from participating or practicing in Texas workers' compensation system
Violation:  Failed to appropriately evaluate injured employee assigned


El Paso County Community College of El Paso
Order Number: DWC-2656
Date of Order:  7/17/2013
Order Final In:   July
Action Taken:  Fined $6,000
Violation:  Failed to accurately submit medical bill and payment data to TDI-DWC


GuideOne Mutual Insurance Company of West Des Moines, IA
Order Number: DWC-2678
Date of Order:  7/30/2013
Order Final In:   July
Action Taken:  Fined $10,000
Violation:  Failed to accurately report electronic data interchange (EDI) medical billing data to TDi-DWC


Labrock Materials, Inc. of Euless, TX
Order Number: DWC-2667
Date of Order:  7/25/2013
Order Final In:   July
Action Taken:  Fined $5,000
Violation:  Failed to timely comply with Commissioner's Order to provide requested information about workers' compensation coverage status


MacMaster, Benzel Christopher M.D. of Dallas
Order Number: DWC-2655
Date of Order:  7/17/2013
Order Final In:   July
Action Taken:  Fined $2,000
Violation:  Failed to adequately document required information in a peer review report


Markel Insurance Company of Glen Allen, VA
Order Number: DWC-2652
Date of Order:  7/17/2013
Order Final In:   July
Action Taken:  Fined $4,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to notify TDI-DWC and injured employee of actions taken on a claim


Protective Insurance Company of Indianapolis, IN
Order Number: DWC-2665
Date of Order:  7/25/2013
Order Final In:   July
Action Taken:  Fined $30,000
Violation:  Failed to provide required claims experience and documentation of loss analysis to policyholders


Texas Mutual Insurance Company of Austin
Order Number: DWC-2666
Date of Order:  7/25/2013
Order Final In:   July
Action Taken:  Fined $6,500
Violation:  Failed to timely pay an advance ordered by TDI-DWC; Failed to timely provide injured employee records to designated doctor; Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange


Tower National Insurance Company of New York, NY
Order Number: DWC-2650
Date of Order:  7/17/2013
Order Final In:   July
Action Taken:  Fined $10,000
Violation:  Failed to accurately submit medical bill and payment data to TDI-DWC


U.S. Toxicology L.L.C. of Dallas
Order Number: DWC-2671
Date of Order:  7/26/2013
Order Final In:   July
Action Taken:  Fined $4,000
Violation:  Failed to comply with TDI-DWC order


Walmart Associates Inc. of Bentonville, AR
Order Number: DWC-2673
Date of Order:  7/26/2013
Order Final In:   July
Action Taken:  Fined $2,500
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports, or records


Walmart Associates, Inc. of Bentonville, AR
Order Number: DWC-2672
Date of Order:  7/26/2013
Order Final In:   July
Action Taken:  Fined $4,000
Violation:  Failed to timely pay indemnity benefits


Wausau Underwriters Insurance Company of Boston, MA
Order Number: DWC-2654
Date of Order:  7/17/2013
Order Final In:   July
Action Taken:  Fined $8,000
Violation:  Failed to timely comply with a TDI-DWC order; Failed to timely pay accrued income benefits following receipt of designated doctors report


Znat Insurance Company of Woodland Hills, CA
Order Number: DWC-2653
Date of Order:  7/17/2013
Order Final In:   July
Action Taken:  Fined $11,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to notify TDI-DWC and injured employee of actions taken on a claim


Center for Injured Workers, Inc. of San Antonio
Order Number: DWC-2551
Date of Order:  5/28/2013
Order Final In:   June
Action Taken:  SOAH DOCKET No. 452-12-1463.C1. Fined $4,000.
Violation:  As non-attorney representative, improperly received fee from workers' compensation claimant


Chubb Indemnity Insurance Company of Warren, NJ
Order Number: DWC-2598
Date of Order:  6/17/2013
Order Final In:   June
Action Taken:  Fined $7,000
Violation:  Failed to timely pay income benefits to injured employee


Desert Imaging Services L.P. of El Paso
Order Number: DWC-2615
Date of Order:  6/27/2013
Order Final In:   June
Action Taken:  Fined $6,000
Violation:  Improperly billed an injured employee for workers' compensation services provided


Employers Preferred Insurance Company of Reno, NV
Order Number: DWC-2597
Date of Order:  6/17/2013
Order Final In:   June
Action Taken:  Fined $7,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to notify TDI-DWC of action taken on a claim


Indemity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-2558
Date of Order:  6/3/2013
Order Final In:   June
Action Taken:  Fined $15,000
Violation:  Failed to comply with TDI-DWC rule and order; Failed to timely pay income benefits to injured employee; Failed to timely pay medical bill or to pay medical bill according to TDI-DWC Medical Fee Guidelines


Mussaji, Murtaza D. O. of Houston
Order Number: DWC-2559
Date of Order:  6/3/2013
Order Final In:   June
Action Taken:  Designated doctor reports to be monitored by TDI-DWC; Random sample of cases to be subject to medical quality review with fees to be paid by doctor
Violation:  Failed to perform complete medical examination of injured employee; Failed to utilize guidelines for return to work; Failed to document analysis of injured worker to determine maximum medical improvement


Reichert, Oscar M., D.O. of Mount Pleasant
Order Number: DWC-2557
Date of Order:  6/3/2013
Order Final In:   June
Action Taken:  Must timely complete specified training
Violation:  Provided treatment which did not promote recovery and/or enhance the ability of injured employee to return to work in timely manner


Buttons L.L.C. of Fort Worth
Order Number: DWC-2494
Date of Order:  5/7/2013
Order Final In:   May
Action Taken:  Fined $1,000
Violation:  Failed to timely comply with a TDI-DWC order


Castlepoint National Insurance Company of New York, NY
Order Number: DWC-2492
Date of Order:  5/7/2013
Order Final In:   May
Action Taken:  Fined $1,000
Violation:  Failed to provide on-site visit or other appropriate service for policyholders


Corley, Ronald G., M.D. of Kyle
Order Number: DWC-2513
Date of Order:  5/10/2013
Order Final In:   May
Action Taken:  Must attend designated doctor training; Medical practice in workers' compensation system subject to medical quality review; Must pay costs of review
Violation:  Failed to adequately document designated doctor examinations; Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Federal Insurance Company of Warren, NJ
Order Number: DWC-2512
Date of Order:  5/10/2013
Order Final In:   May
Action Taken:  Fined $6,000
Violation:  Failed to timely comply with a TDI-DWC order


Liberty Insurance Corporation of Boston, MA
Order Number: DWC-2532
Date of Order:  5/21/2013
Order Final In:   May
Action Taken:  Fined $3,800
Violation:  Failed to timely pay income benefits to injured employee


Meadowmere Emergency Physicians of Philadelphia
Order Number: DWC-2495
Date of Order:  5/7/2013
Order Final In:   May
Action Taken:  Fined $2,500
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Quest Diagnostics Inc. of Norristown, PA
Order Number: DWC-2514
Date of Order:  5/10/2013
Order Final In:   May
Action Taken:  Fined $4,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


St. David's Medical Center Austin of Austin
Order Number: DWC-2482
Date of Order:  5/3/2013
Order Final In:   May
Action Taken:  Fined $2,500
Violation:  Improperly billed an injured employee for workers' compensation services provided

Texas Municipal League Intergovernmental Risk Pool of Austin
Order Number: DWC-2496
Date of Order:  5/7/2013
Order Final In:   May
Action Taken:  Fined $15,000
Violation:  Failed to accurately submit medical bill and payment data


Weiser Security Services, Inc. of New Orleans, LA
Order Number: DWC-2493
Date of Order:  5/7/2013
Order Final In:   May
Action Taken:  Fined $2,500
Violation:  Failed to file wage statement with injured employee


Associated Indemnity Corporation of Novato, CA
Order Number: DWC-2474
Date of Order:  4/29/2013
Order Final In:   April
Action Taken:  Fined $2,400
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely pay medical bill or to pay medical bill according to TDI-DWC Medical Fee Guidelines


Chevron Corporation of San Ramon, CA
Order Number: DWC-2438
Date of Order:  4/12/2013
Order Final In:   April
Action Taken:  Fined $2,000
Violation:  Failed to pay correct amount of Temporary Income Benefits to injured worker


Nguyen-Khoa, Kevin Quang D.P.M. of Richardson
Order Number: DWC-2439
Date of Order:  4/12/2013
Order Final In:   April
Action Taken:  Must submit care of injured employees for Medical Quality Review and be subject to possible future enforcement action
Violation:  Misrepresented or omitted pertinent facts in a medical evaluation and narrative report while serving as Designated Doctor


Poly America, L.P. of Grand Prairie
Order Number: DWC-2437
Date of Order:  4/12/2013
Order Final In:   April
Action Taken:  Fined $23,500
Violation:  Failed to timely pay medical bill or to pay medical bill according to TDI-DWC Medical Fee Guidelines; Failed to accurately submit medical bill and payment data


Roybal, Robert Edward M.D. of Dallas
Order Number: DWC-2440
Date of Order:  4/12/2013
Order Final In:   April
Action Taken:  Must attend compliance training for doctors and medical office staff; Must undergo monitoring and review of randomly selected workers' compensation patients records
Violation:  Failed to properly document and explain findings from examinations of injured employees


St. Luke's Episcopal Health System of Houston
Order Number: DWC-2461
Date of Order:  4/26/2013
Order Final In:   April
Action Taken:  Fined $3,500
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Vega, Oscar M.D. of El Paso
Order Number: DWC-2475
Date of Order:  4/29/2013
Order Final In:   April
Action Taken:  Fined $4,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


AMA Regal, Inc. of Londonderry, NJ
Order Number: DWC-2380
Date of Order:  3/15/2013
Order Final In:   March
Action Taken:  Fined $500
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


American Home Assurance Company of New York, NY
Order Number: DWC-2387
Date of Order:  3/22/2013
Order Final In:   March
Action Taken:  Fined $5,500
Violation:  Failed to timely pay medical bill; Failed to timely comply with a benefit dispute agreement


Arrowhead Hospital of Glendale, AZ
Order Number: DWC-2390
Date of Order:  3/22/2013
Order Final In:   March
Action Taken:  Fined $2,000
Violation:  Improperly billed an injured employee for workers’ compensation medical services provided


Greater San Antonio Emergency Physicians of San Antonio
Order Number: DWC-2386
Date of Order:  3/22/2013
Order Final In:   March
Action Taken:  Fined $2,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC-2389
Date of Order:  3/22/2013
Order Final In:   March
Action Taken:  Fined $7,000
Violation:  Failed to timely pay income benefits to injured employee


Renaissance SNF, L.L.C. of Dallas
Order Number: DWC-2379
Date of Order:  3/15/2013
Order Final In:   March
Action Taken:  Fined $1,500
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Standard Fire Insurance Company of Hartford, CT
Order Number: DWC-2388
Date of Order:  3/22/2013
Order Final In:   March
Action Taken:  $5,000
Violation:  Failed to timely pay income benefits to injured employee


TSC Staffing Solutions, Inc. of Bedford
Order Number: DWC-2391
Date of Order:  3/22/2013
Order Final In:   March
Action Taken:  Fined $1,500
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Wolinsky, Joel Scott M.D. of Sugar Land
Order Number: DWC-2378
Date of Order:  3/15/2013
Order Final In:   March
Action Taken:  Fined $5,000
Violation:  Failed or refused to reply to TDI-DWC order to produce documents


American Home Assurance Company of New York, NY
Order Number: DWC-2301
Date of Order:  2/20/2013
Order Final In:   February
Action Taken:  Fined $2,000
Violation:  Inappropriately required preauthorization of prescription drugs on a non-network legacy claim


Andrew, John Gray M.D. of Friendswood
Order Number: DWC-2322
Date of Order:  2/28/2013
Order Final In:   February
Action Taken:  Must complete assessment of practice to determine need for education plan.
Violation:  Failed to meet requirements for performing and documenting examinations of injured workers to determine impairment ratings


Argonaut-Southwest Insurance Company of San Antonio
Order Number: DWC-2318
Date of Order:  2/28/2013
Order Final In:   February
Action Taken:  Fined $24,000
Violation:  Failed to timely pay medical bill or to pay medical bill according to TDI-DWC Medical Fee Guidelines; Failed to accurately submit medical bill and payment data


Burnet 1 Enterprises L.L.C. D/B/A Oaks Nursing Center of Burnet
Order Number: DWC-2310
Date of Order:  2/22/2013
Order Final In:   February
Action Taken:  Fined $600
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Clear Lake Regional Medical Center of Louisville, KY
Order Number: DWC-2325
Date of Order:  2/28/2013
Order Final In:   February
Action Taken:  Fined $2,500
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Douglas, Howard Thomas III, M.D. of Corinth
Order Number: DWC-2319
Date of Order:  2/28/2013
Order Final In:   February
Action Taken:  Removed from designated doctor list
Violation:  Performed designated doctor examination when not appointed by TDI-DWC 
or by mutual agreement of the parties


Fallon, Michael A., M.D. of El Paso
Order Number: DWC-2316
Date of Order:  2/27/2013
Order Final In:   February
Action Taken:  Fined $6,000
Violation:  Failed to timely provide medical records of an injured employee after being ordered to produce them


Houston Independent School District of Houston
Order Number: DWC-2326
Date of Order:  2/28/2013
Order Final In:   February
Action Taken:  Fined $5,000
Violation:  Failed to timely pay income benefits to injured employee


Johnson, George Howell, Sr., D.O. of Deer Park
Order Number: DWC-2320
Date of Order:  2/28/2013
Order Final In:   February
Action Taken:  Designated doctor reports must be monitored by TDI-DWC for one year
Violation:  Failed to meet requirements for performing and documenting examination of injured worker to determine maximum medical improvement


Kennedy, Charles W., Jr., M.D. of Corpus Christi
Order Number: DWC-2323
Date of Order:  2/28/2013
Order Final In:   February
Action Taken:  Must complete a medical record-keeping course and submit reports of designated doctor examinations to TDI-DWC for monitoring
Violation:  Failed to adequately document medical evaluations and assign impairment ratings


Oberoi, Asra M.D. of Dallas
Order Number: DWC-2324
Date of Order:  2/28/2013
Order Final In:   February
Action Taken:  Will not be assigned designated doctor examinations, MMI, or IR ratings examinations until new certification is approved
Violation:  Failed to identify specific findings in impairment analysis and failed to recognize the statutory maximum medical improvement date


PF&B Management, GP L.L.C. of Houston
Order Number: DWC-2304
Date of Order:  2/20/2013
Order Final In:   February
Action Taken:  Fined $1,000
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Philbrick, Darey Allen M.D. of Kyle
Order Number: DWC-2327
Date of Order:  2/28/2013
Order Final In:   February
Action Taken:  Removed from Texas workers' compensation system as a health care practitioner
Violation:  Medical license cancelled


Third Coast Fresh Distribution L.L.C. of Houston
Order Number: DWC-2314
Date of Order:  2/27/2013
Order Final In:   February
Action Taken:  Fined $500
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Ullico Casualty Company of Washington, D.C.
Order Number: DWC-2303
Date of Order:  2/20/2013
Order Final In:   February
Action Taken:  Fined $55,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely process medical bills; Failed to timely report benefit data toTDI- DWC or accurately submit benefit data by electronic data interchange; Failed to timely file DWC EDI-03 forms; Failed to pay for services that were preauthorized; Failed to timely process a preauthorization request; and Failed to timely file its accident prevention services annual report


Viesca, Carlos O., M.D. of El Paso
Order Number: DWC-2315
Date of Order:  2/27/2013
Order Final In:   February
Action Taken:  Fined $6,000
Violation:  Failed to timely provide medical records of an injured employee after being ordered to produce them


Wiggins, Joe W., D.C. of Canyon Lake
Order Number: DWC-2321
Date of Order:  2/28/2013
Order Final In:   February
Action Taken:  Must complete AADEP course and submit reports of designated doctor examinations for monitoring after completion of AADEP course 
Violation:  Failed to adequately perform and complete reports for designated doctor examinations; Failed to perform or refer injured workers for appropriate testing


American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-2201
Date of Order:  1/18/2013
Order Final In:   January
Action Taken:  Fined $4,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely comply with a TDI-DWC order


Design Transportation Services Inc. of Dallas
Order Number: DWC-2231
Date of Order:  1/25/2013
Order Final In:   January
Action Taken:  Fined $3,000
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Farmers Insurance Exchange of Austin
Order Number: DWC-2200
Date of Order:  1/18/2013
Order Final In:   January
Action Taken:  Fined $3,000
Violation:  Failed to provide on-site visit or other appropriate services at least every 12 months for policyholders


Federal Insurance Company of Warren, NJ
Order Number: DWC-2202
Date of Order:  1/18/2013
Order Final In:   January
Action Taken:  Fined $36,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately provide benefit payment and medical bill data


Kirkwood, John Dale D.O. of Pasadena
Order Number: DWC-2241
Date of Order:  1/30/2013
Order Final In:   January
Action Taken:  Fined $4,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Lightner, Oscar N., M.D. of Laredo
Order Number: DWC-2240
Date of Order:  1/30/2013
Order Final In:   January
Action Taken:  Fined $7,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Mid-Century Insurance Company of Austin
Order Number: DWC-2198
Date of Order:  1/18/2013
Order Final In:   January
Action Taken:  Fined $14,360
Violation:  Failed to accurately submit medical bill data to TDI-DWC via electronic data interchange; Failed to provide on-site visit or other appropriate services for policyholders


National Interstate Insurance Company of Richfield, OH
Order Number: DWC-2230
Date of Order:  1/25/2013
Order Final In:   January
Action Taken:  Fined $23,000
Violation:  Failed to timely pay or deny medical bills and to accurately and/or timely submit reports to TDI-DWC


Shell US Hosting Company of Houston
Order Number: DWC-2171
Date of Order:  1/8/2013
Order Final In:   January
Action Taken:  Fined $2,500
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Sonic Advantage P.A., L.P. of Houston
Order Number: DWC-2170
Date of Order:  1/8/2013
Order Final In:   January
Action Taken:  Fined $750
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Texas Automobile Dealers Self Insurers Group of Austin
Order Number: DWC-2186
Date of Order:  1/11/2013
Order Final In:   January
Action Taken:  Fined $15,000
Violation:  Failed to accurately submit medical bill and payment data to TDI-DWC


Truck Insurance Exchange of Austin
Order Number: DWC-2199
Date of Order:  1/18/2013
Order Final In:   January
Action Taken:  Fined $13,120
Violation:  Failed to accurately submit medical bill data to TDI-DWC via electronic data interchange; Failed to provide on-site visit or other appropriate services for policyholders


2012


Albrand, Otmar Wolf M.D. of Kyle
Order Number:  DWC-12-0171
Date of Order: 10/12/2012
Order Final In: October
Action Taken: Suspended from Designated Doctor List
Violation: Failed to perform additional relevant testing or to refer injured employee to other health care providers to determine medical issue; Improperly determined impairment rating


American Hardware Mutual Insurance Company of Columbus, OH
Order Number: DWC-12-0178
Date of Order: 10/17/2012
Order Final In: October
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Baker, Gregory Wayne D.C. of Pasadena
Order Number: DWC-12-0174
Date of Order: 10/17/2012
Order Final In: October
Action Taken: Removed from Designated Doctor List; Deprived of right to certify maximum medical improvement and/or assign impairment ratings in the workers' compensation system
Violation: Performed a designated doctor examination without appointment from Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Bradford Holding Company, Inc. of Corpus Christi
Order Number: DWC-12-0183
Date of Order: 10/29/2012
Order Final In: October
Action Taken: Fined $21,000
Violation: Failed to accurately submit medical bill and payment data; Failed to timely pay medical bill or to pay medical bill according to Texas Department of Insurance - Division of Workers Compensation TDI-DWC Medical Fee Guidelines


Capitol City Insurance Company of New York, NY
Order Number: DWC-12-0169
Date of Order: 10/12/2012
Order Final In: October
Action Taken: Fined $2,500
Violation: Failed to notify Texas Department of Insurance - Division of Workers Compensation TDI-DWC and injured employee of actions taken on a claim; Failed to accurately submit medical bill and payment data


City of Arlington of Arlington
Order Number: DWC-12-0177
Date of Order: 10/17/2012
Order Final In: October
Action Taken: Fined $11,500
Violation: Failed to accurately submit medical bill and payment data


Dish Network Corporation of Conroe
Order Number: DWC-12-0167
Date of Order: 10/5/2012
Order Final In: October
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records; Failed to comply with order or decision of Commissioner of Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Hartford Insurance Company of the Midwest of Hartford, CT
Order Number: DWC-12-0186
Date of Order: 10/29/2012
Order Final In: October
Action Taken: Fined $5,000
Violation: Failed to accurately submit medical bill and payment data


Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-12-0185
Date of Order: 10/29/2012
Order Final In: October
Action Taken: Fined $6,960
Violation: Failed to accurately submit medical bill and payment data


Lumbermen's Underwriting Alliance of Boca Raton, FL
Order Number: DWC-12-0184
Date of Order: 10/29/2012
Order Final In: October
Action Taken: Fined $4,600
Violation: Failed to accurately submit medical bill and payment data


Meridian Security Insurance Company of Indianapolis, IN
Order Number: DWC-12-0176
Date of Order: 10/17/2012
Order Final In: October
Action Taken: Fined $34,300
Violation: Failed to accurately submit medical bill and payment data; Failed to timely pay medical bill or to pay medical bill according to Texas Department of Insurance - Division of Workers Compensation TDI-DWC Medical Fee Guidelines


National American Insurance Company of Chandler, OK
Order Number: DWC-12-0187
Date of Order: 10/29/2012
Order Final In: October
Action Taken: Fined $5,760
Violation: Failed to accurately submit medical bill and payment data


Petroleum Casualty Company of Austin
Order Number: DWC-12-0188
Date of Order: 10/29/2012
Order Final In: October
Action Taken: Fined $2,400
Violation: Failed to accurately submit medical bill and payment data


Praetorian Insurance Company of New York, NY
Order Number: DWC-12-0170
Date of Order: 10/12/2012
Order Final In: October
Action Taken: Fined $30,000
Violation: Failed to timely pay medical bill or to pay medical bill according to Texas Department of Insurance - Division of Workers Compensation TDI-DWC Medical Fee Guidelines; Failed to accurately submit medical bill and payment data


Soignier, Wayne A., M.D. of Kyle
Order Number: DWC-12-0173
Date of Order: 10/17/2012
Order Final In: October
Action Taken: Permanently removed from designated doctor list
Violation: Failed to perform Texas Department of Insurance - Division of Workers Compensation TDI-DWC ordered designated doctor examinations in accordance with AMA Guidelines; Submitted inaccurate or incomplete reports; Failed to follow statutes and rules for designated doctor appointments and reporting to Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Southern Vanguard Insurance Company of Dallas
Order Number: DWC-12-0166
Date of Order: 10/5/2012
Order Final In: October
Action Taken: Fined $15,500
Violation: Failed to accurately submit medical bill and payment data; Failed to timely pay medical bill or to pay medical bill according to Texas Department of Insurance - Division of Workers Compensation TDI-DWC Medical Fee Guidelines


Sparta Insurance Company of Hartford, CT
Order Number: DWC-12-0168
Date of Order: 10/5/2012
Order Final In: October
Action Taken: Fined $9,500
Violation: Failed to timely pay income benefits to injured employee


Texas A & M University of College Station
Order Number: DWC-12-0165
Date of Order: 10/5/2012
Order Final In: October
Action Taken: Fined $3,000
Violation: Failed to timely pay income benefits to injured employee; Failed to timely or accurately report dates for first notice, disability, and initial payment


Texas Builders Insurance Company of Austin
Order Number: DWC-12-0172
Date of Order: 10/17/2012
Order Final In: October
Action Taken: Fined $2,500
Violation: Failed to accurately submit medical bill and payment data


Transguard Insurance Company of America, Inc. of Naperville, IL
Order Number: DWC-12-0175
Date of Order: 10/17/2012
Order Final In: October
Action Taken: Fined $1,000
Violation: Failed to timely file accident prevention services annual report for calendar year 2011


Vanliner Insurance Company of St. Louis, MO
Order Number: DWC-12-0179
Date of Order: 10/17/2012
Order Final In: October
Action Taken: $17,000
Violation: Failed to accurately submit medical bill and payment data; Failed to timely pay medical bill or to pay medical bill according to Texas Department of Insurance - Division of Workers Compensation TDI-DWC Medical Fee Guidelines


Vredenburgh, Jesse William D.O. of Corpus Christi
Order Number: DWC-12-0182
Date of Order: 10/23/2012
Order Final In: October
Action Taken: Fined $5,000; Suspended from designated doctors list for one year
Violation: Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Benchmark Insurance Company of Eden Prairie, MN
Order Number: DWC-12-0159
Date of Order: 9/26/2012
Order Final In: September
Action Taken: Fined $5,000
Violation: Failed to provide on-site visit or other appropriate services to policyholders with $25,000 or more in premium


Berkshire Hathaway Homestate Insurance Company of San Francisco, CA
Order Number: DWC-12-0163
Date of Order: 9/26/2012
Order Final In: September
Action Taken: Fined $14,760
Violation: Failed to accurately and timely submit medical bill data


Brown, George Erwin, Jr., M.D. of Deer Park
Order Number: DWC-12-0161
Date of Order: 9/26/2012
Order Final In: September
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports or records; Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Castlepoint National Insurance Company of Chicago, IL
Order Number: DWC-12-0157
Date of Order: 9/26/2012
Order Final In: September
Action Taken: Fined $12,000
Violation: Failed to provide on-site visit or other appropriate services to policyholders with $25,000 or more in premium; Failed to provide written solicitation of comments from each policyholder at least every 12 months


City of Amarillo of Amarillo
Order Number: DWC-12-0156
Date of Order: 9/26/2012
Order Final In: September
Action Taken: Fined $10,000
Violation: Failed to accurately submit medical bill and payment data; Failed to timely pay medical bill or to pay medical bill according to Texas Department of Insurance - Division of Workers Compensation TDI-DWC Medical Fee Guidelines


Clarendon National Insurance Company of New York, NY
Order Number: DWC-12-0162
Date of Order: 9/28/2012
Order Final In: September
Action Taken: Fined $12,500
Violation: Failed to timely pay medical bill or to pay medical bill according to Texas Department of Insurance - Division of Workers Compensation TDI-DWC Medical Fee Guidelines; Failed to accurately submit medical bill and payment data


Sentry Insurance, A Mutual Company of Stevens Point, WI
Order Number: DWC-12-0160
Date of Order: 9/26/2012
Order Final In: September
Action Taken: Fined $13,750
Violation: Failed to timely pay income benefits to injured employee; Failed to accurately submit medical bill and payment data


Small Bone Innovations, Inc. of New York, NY
Order Number: DWC-12-0153
Date of Order: 9/10/2012
Order Final In: September
Action Taken: Fined $3,000
Violation: Misused the name of TDI-DWC


Soignier, Wayne M., M.D. of Dallas
Order Number: DWC-12-0154
Date of Order: 9/14/2012
Order Final In: September
Action Taken: Prohibited from providing health care in the Texas workers compensation system, including serving as a designated doctor
Violation: Exhibited a professional failure to practice medicine in an acceptable manner consistent with public health, safety and welfare; Submitted inaccurate or inappropriate reports as a pattern of practice due to insufficient examination and analysis of medical records


Tower National Insurance Company of New York City, NY
Order Number: DWC-12-0158
Date of Order: 9/20/2012
Order Final In: September
Action Taken: Fined $5,000
Violation: Failed to provide on-site visit or other appropriate services to policyholders with $25,000 or more in premium; Failed to provide written solicitation of comments from each policyholder at least every 12 months


American Home Assurance Co. of New York, NY
Order Number: DWC-12-0144
Date of Order: 8/10/2012
Order Final In: August
Action Taken: Fined $20,784
Violation: Failed to pay correct amount of income benefits to injured employee


Commerce and Industry Insurance Company of New York City, NY
Order Number: DWC-12-0151
Date of Order: 8/20/2012
Order Final In: August
Action Taken: Fined $4,800
Violation: Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Cunningham & Moore Inc. of Dallas
Order Number: DWC-12-0142
Date of Order: 8/10/2012
Order Final In: August
Action Taken: Fined $1,000
Violation: Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Dallas Independent School District of Dallas
Order Number: DWC-12-0138
Date of Order: 8/3/2012
Order Final In: August
Action Taken: Fined $17,000
Violation: Failed to timely pay income benefits to injured employee; Failed to accurately submit medical bill and payment data


Elite PHC Corporation of Los Fresnos
Order Number: DWC-12-0140
Date of Order: 8/10/2012
Order Final In: August
Action Taken: Fined $1,500
Violation: Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Fortress Health and Rehab of Rock Prairie, L.L.C. of College Station
Order Number: DWC-12-0146
Date of Order: 8/10/2012
Order Final In: August
Action Taken: Fined $750
Violation: Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Golden Restaurants, Inc. of Dallas
Order Number: DWC-12-0149
Date of Order: 8/16/2012
Order Final In: August
Action Taken: Fined $1,500
Violation: Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Harlingen Acute Care, Inc. of Harlingen
Order Number: DWC-12-0139
Date of Order: 8/3/2012
Order Final In: August
Action Taken: Fined $500
Violation: Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Houston Personal Touch Home Aides, Inc. of San Antonio
Order Number: DWC-12-0152
Date of Order: 8/20/2012
Order Final In: August
Action Taken: Fined $500
Violation: Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Illinois National Insurance Company of New York, NY
Order Number: DWC-12-0148
Date of Order: 8/16/2012
Order Final In: August
Action Taken: Fined $5,856
Violation: Failed to pay correct amount of income benefits to injured employee


Illinois National Insurance Company of New York, NY
Order Number: DWC-12-0148
Date of Order: 8/16/2012
Order Final In: August
Action Taken: Fined $5,856
Violation: Failed to pay the correct amount of temporary income benefits to in 122 injured employee cases


J & J Home Health of Burleson
Order Number: DWC-12-0141
Date of Order: 8/10/2012
Order Final In: August
Action Taken: Fined $10,000
Violation: Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


New Hampshire Insurance Company of New York, NY
Order Number: DWC-12-0145
Date of Order: 8/10/2012
Order Final In: August
Action Taken: Fined $18,096
Violation: Failed to pay the correct amount of income benefits to injured employee


Old Republic Insurance Company of Greenburg, PA
Order Number: DWC-12-0143
Date of Order: 8/10/2012
Order Final In: August
Action Taken: Fined $2,000
Violation: Failed to timely pay income benefits to injured employee


Radadvantage APC of Santa Monica, CA
Order Number: DWC-12-0137
Date of Order: 8/3/2012
Order Final In: August
Action Taken: Fined $2,000
Violation: Improperly billed an injured employee for workers' compensation medical services provided


The Insurance Company of the State of Pennsylvania of New York, NY
Order Number: DWC-12-0147
Date of Order: 8/16/2012
Order Final In: August
Action Taken: Fined $576
Violation: Failed to pay the correct amount of temporary income benefits to in 12 injured employee cases


American Safety Casualty Insurance Company of Austin
Order Number: DWC-12-0135
Date of Order: 7/16/2012
Order Final In: July
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Arch Insurance Company of New York, NY
Order Number: DWC-12-0134
Date of Order: 7/16/2012
Order Final In: July
Action Taken: Fined $26,500
Violation: Failed to timely pay indemnity benefits; Failed to timely submit benefit data to TDI-DWC; Failed to accurately report benefit data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC or accurately submit benefit data by electronic data interchange


Belmont Care Center, LTD, Co. of Allen
Order Number: DWC-12-0107
Date of Order: 7/2/2012
Order Final In: July
Action Taken: Fined $1,000
Violation: Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status

Cincinnati Insurance Company of Fairfield, OH
Order Number: DWC-12-0118
Date of Order: 7/6/2012
Order Final In: July
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Commercial Casualty Insurance Company of Round Rock
Order Number: DWC-12-0112
Date of Order: 7/2/2012
Order Final In: July
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Connecticut Indemnity Company of Addison
Order Number: DWC-12-0132
Date of Order: 7/16/2012
Order Final In: July
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Cooper US, Inc. of Houston
Order Number: DWC-12-0128
Date of Order: 7/16/2012
Order Final In: July
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Cortlandt Insurance Company of Round Rock
Order Number: DWC-12-0111
Date of Order: 7/2/2012
Order Final In: July
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Fire and Casualty Insurance Company of Connecticut of Addison
Order Number: DWC-12-0129
Date of Order: 7/16/2012
Order Final In: July
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Fiserv Par, Inc. of Brookfield, WI
Order Number: DWC-12-0113
Date of Order: 7/2/2012
Order Final In: July
Action Taken: Fined $1,000
Violation: Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Fowler, Stephen Rice M.D. of Ennis
Order Number: DWC-12-0127
Date of Order: 7/16/2012
Order Final In: July
Action Taken: Removed from providing health care in workers' compensation system
Violation: License suspended by Texas Medical Board; Failed to practice medicine or provide health care in a manner consistent with the public health, safety and welfare


Iberville Management, LLC, et al. of Tyler
Order Number: DWC-12-0105
Date of Order: 7/2/2012
Order Final In: July
Action Taken: Fined $500
Violation: Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Manufacturers Alliance Insurance Company of Blue Bell, PA
Order Number: DWC-12-0114
Date of Order: 7/2/2012
Order Final In: July
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Mega Gulf Coast Lines, Inc. of Grand Prairie
Order Number: DWC-12-0104
Date of Order: 6/27/2012
Order Final In: July
Action Taken: Fined $1,000
Violation: Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Pennsylvania Manufacturers Association Insurance Company of Blue Bell, PA
Order Number: DWC-12-0110
Date of Order: 7/2/2012
Order Final In: July
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Pennsylvania Manufacturer's Indemnity Company of Blue Bell, PA
Order Number: DWC-12-0115
Date of Order: 7/2/2012
Order Final In: July
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


PPG Industries, Inc. of Pittsburgh, PA
Order Number: DWC-12-0133
Date of Order: 7/16/2012
Order Final In: July
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Public Auto Sales Inc. et al of Dallas
Order Number: DWC-12-0108
Date of Order: 7/2/2012
Order Final In: July
Action Taken: Fined $500
Violation: Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Royal Insurance Company of America of Addison
Order Number: DWC-12-0130
Date of Order: 7/16/2012
Order Final In: July
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


RWS Weatherford Operator L.L.C. of Weatherford
Order Number: DWC-120106
Date of Order: 7/2/2012
Order Final In: July
Action Taken: Fined $1,500
Violation: Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC; Failed to timely file report of employee injury, illness or death


Sam Kane Beef Processors, Inc. of Corpus Christi
Order Number: DWC-12-0126
Date of Order: 7/16/2012
Order Final In: July
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Security Insurance Company of Hartford of Addison
Order Number: DWC-12-0131
Date of Order: 7/16/2012
Order Final In: July
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Sherwin Williams Company of Cleveland, OH
Order Number: DWC-12-0109
Date of Order: 7/2/2012
Order Final In: July
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Siddiqi, Zahida M.D. of Houston
Order Number: DWC-12-0136
Date of Order: 7/31/2012
Order Final In: July
Action Taken: Removed from Designated Doctor's List; Must not perform maximum medical improvement examinations and/or assign impairment ratings in workers' compensation system; Must perform any re-examinations on injured employees ordered by TDI-DWC Texas Department of Insurance - Division of Workers Compensation
Violation: Failed to perform scheduled Designated Doctor examinations; Submitted charges for health care services which were not performed


Syed, Shahid Hussain M.D. of Houston
Order Number: DWC-12-0116
Date of Order: 7/2/2012
Order Final In: July
Action Taken: Must complete Continuing Medical Education course
Violation: Failed to provide healthcare that promoted recovery or enhanced ability of injured employee to return to work


Dallas Lighthouse for the Blind Inc. of Dallas
Order Number: DWC-120099
Date of Order:  6/18/2012
Order Final In:   June
Action Taken:  Fined $500
Violation:  Failed to timely respond to a TDI-DWC request for information; Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC

Farmington Casualty Company of Hartford, CT
Order Number: DWC-120102
Date of Order:  6/20/2012
Order Final In:   June
Action Taken:  Fined $7,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely or accurately submit medical bill and payment data


Moore Staffing Company of Mont Belvieu
Order Number: DWC-120101
Date of Order:  6/20/2012
Order Final In:   June
Action Taken:  Fined $500
Violation:  Failed to timely respond to a TDI-DWC request for information; Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Old Republic Insurance Company of Greensburg, PA
Order Number: DWC-120095
Date of Order:  6/11/2012
Order Final In:   June
Action Taken:  Fined $5,000
Violation:  Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Polytex Fibers Corp. of Houston
Order Number: DWC-120098
Date of Order:  6/18/2012
Order Final In:   June
Action Taken:  Fined $500
Violation:  Failed to timely respond to a TDI-DWC request for information; Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Stanley Works of New Britain, CT
Order Number: DWC-120096
Date of Order:  6/18/2012
Order Final In:   June
Action Taken:  Fined $3,000
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


United Commerce Center, Inc. of Irving
Order Number: DWC-120097
Date of Order:  6/18/2012
Order Final In:   June
Action Taken:  Fined $500
Violation:  Failed to timely respond to a TDI-DWC request for information; Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Wal Mart Associates, Inc. of Bentonville, AR
Order Number: DWC-120100
Date of Order:  6/20/2012
Order Final In:   June
Action Taken:  Fined $7,500
Violation:  Failed to timely pay death benefits to Subsequent Injury Fund


American Home Assurance Company of New York, NY
Order Number: DWC-12-0076
Date of Order:  5/14/2012
Order Final In:   May
Action Taken:  Fined $4,200
Violation:  Failed to timely reimburse injured employee for travel expenses; Failed to pay death benefits at correct rate


AOC Senior Home Health Corporation of Howe
Order Number: DWC-12-0080
Date of Order:  5/18/2012
Order Final In:   May
Action Taken:  Fined $500
Violation:  Failed to timely comply with a Texas Department of Insurance - Division of Workers Compensation TDI-DWC order to provide workers compensation coverage status


August, Brian James M.D. of El Paso
Order Number: DWC-12-0084
Date of Order:  5/21/2012
Order Final In:   May
Action Taken:  Removed from Designated Doctor List
Violation:  Failed to comply with order or decision of Commissioner or TDI-DWC; Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Axiom Home Health Inc. of San Antonio
Order Number: DWC-12-0082
Date of Order:  5/18/2012
Order Final In:   May
Action Taken:  Fined $1,000
Violation:  Failed to timely comply with a Texas Department of Insurance - Division of Workers Compensation TDI-DWC order to provide workers compensation coverage status


Chimanji, Mahanprakash D., M.D. of Dallas
Order Number: DWC-12-0078
Date of Order:  5/16/2012
Order Final In:   May
Action Taken:  Must complete Designated Doctor course and course certification examination within 180 days
Violation:  Failed to properly perform and/or document an adequate Designated Doctor examination


El Paso Orthopaedic Surgery Group of El Paso
Order Number: DWC-12-0090
Date of Order:  5/30/2012
Order Final In:   May
Action Taken:  Fined $1,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Fields Fast Foods F.L.P. of Rosenberg
Order Number: DWC-12-0075
Date of Order:  5/14/2012
Order Final In:   May
Action Taken:  Fined $1,500
Violation:  Failed to timely comply with a Texas Department of Insurance - Division of Workers Compensation TDI-DWC order to provide workers compensation coverage status


Fries Restaurant Management L.L.C. Burger King of Dallas
Order Number: DWC-12-0091
Date of Order:  5/30/2012
Order Final In:   May
Action Taken:  Fined $1,000
Violation:  Failed to timely comply with a Texas Department of Insurance - Division of Workers Compensation TDI-DWC order to provide workers compensation coverage status


Irving Laboratories PA of Dallas
Order Number: DWC-12-0085
Date of Order:  5/22/2012
Order Final In:   May
Action Taken:  Fined $500
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


La Bianca, Inc. of Ennis
Order Number: DWC-12-0088
Date of Order:  5/24/2012
Order Final In:   May
Action Taken:  Fined $500
Violation:  Failed to timely comply with a Texas Department of Insurance - Division of Workers Compensation TDI-DWC order to provide workers compensation coverage status


LM Insurance Corporation of Boston, MA
Order Number: DWC-12-0083
Date of Order:  5/21/2012
Order Final In:   May
Action Taken:  Fined $62,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to notify injured employee and Texas Department of Insurance - Division of Workers Compensation TDI-DWC of actions taken on a claim


McShane, Ricky Michael D.O. of Deer Park
Order Number: DWC-12-0089
Date of Order:  5/30/2012
Order Final In:   May
Action Taken:  Removed from Designated Doctor List
Violation:  Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC; Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Nickep Enterprises of Dallas
Order Number: DWC-12-0077
Date of Order:  5/14/2012
Order Final In:   May
Action Taken:  Fined $1,000
Violation:  Failed to timely comply with a Texas Department of Insurance - Division of Workers Compensation TDI-DWC order to provide workers compensation coverage status


Patel, Manish V., M.D. of Austin
Order Number: DWC-12-0092
Date of Order:  5/30/2012
Order Final In:   May
Action Taken:  Fined $5,000
Violation:  Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Quest Diagnostics Inc. of Madison, NJ
Order Number: DWC-12-0074
Date of Order:  5/14/2012
Order Final In:   May
Action Taken:  Fined $3,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Richards, Barna Allen M.D. of Arlington
Order Number: DWC-12-0073
Date of Order:  5/14/2012
Order Final In:   May
Action Taken:  Must attend approved educational course or event related to medical practice in Texas workers' compensation system
Violation:  Failed to appropriately certify maximum medical improvement; Failed to properly determine injured employee's impairment rating; Failed to perform additional testing or refer an employee to other health care providers when necessary


The Netherlands Insurance Company of Boston, MA
Order Number: DWC-12-0079
Date of Order:  5/18/2012
Order Final In:   May
Action Taken:  Fined $8,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately submit medical bill and payment data


Trudy's Texas Star, Inc. of Austin
Order Number: DWC-12-0086
Date of Order:  5/22/2012
Order Final In:   May
Action Taken:  Fined $1,500
Violation:  Failed to timely provide information requested by Texas Department of Insurance - Division of Workers Compensation TDI-DWC; Failed to timely file non-covered employer's report of occupational injury or illness


Ultra Medical Cleaning of Stafford
Order Number: DWC-12-0081
Date of Order:  5/18/2012
Order Final In:   May
Action Taken:  Fined $1,000
Violation:  Failed to timely comply with a Texas Department of Insurance - Division of Workers Compensation TDI-DWC order to provide workers compensation coverage status


Williams Fried Chicken, Inc. of Dallas
Order Number: DWC-12-0094
Date of Order:  5/31/2012
Order Final In:   May
Action Taken:  Fined $500
Violation:  Failed to timely comply with a Texas Department of Insurance - Division of Workers Compensation TDI-DWC order to provide workers compensation coverage status


Zegarelli, Louis D., D.O. of Dallas
Order Number: DWC-12-0093
Date of Order:  5/31/2012
Order Final In:   May
Action Taken:  Must attend University of California at SanDiego PACE course in clinician-patient communications within 180 days
Violation:  Provided long-term care and pain management without any resulting improvement or return to work


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-12-0087
Date of Order:  5/24/2012
Order Final In:   May
Action Taken:  Fined $35,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to notify Texas Department of Insurance - Division of Workers Compensation TDI-DWC and injured employee of actions taken on a claim


Baylor Medical Center at Irving of Irving
Order Number: DWC-120054
Date of Order:  4/9/2012
Order Final In:   April
Action Taken:  Fined $2,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Beech Street, A Viant Network of Lake Forest, CA
Order Number: DWC-120055
Date of Order:  4/9/2012
Order Final In:   April
Action Taken:  Fined $26,500
Violation:  Failed to provide TDI-DWC with accurate list of insurance carriers in informal network; Failed to timely provide information to Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Bon Appetit Management Company of Charlotte, NC
Order Number: DWC-120062
Date of Order:  4/23/2012
Order Final In:   April
Action Taken:  Fined $3,000
Violation:  Failed to timely provide TDI-DWC with requested information about workers' compensation coverage status; Failed to comply with Texas Department of Insurance - Division of Workers Compensation TDI-DWC order


Cherokee Insurance Company of Sterling Heights, MI
Order Number: DWC-120051
Date of Order:  4/2/2012
Order Final In:   April
Action Taken:  Fined $4,000
Violation:  Failed to comply with Commissioner rule or decision; Failed to timely pay income benefits to injured employee


Danshaw, Craig Brian D.O. of Fort Worth
Order Number: DWC-120058
Date of Order:  4/18/2012
Order Final In:   April
Action Taken:  Must complete medical recordkeeping course; Must comply with monitoring review of care provided to injured employees
Violation:  Failed to provide reasonable and necessary health care


Henry, Mark Howard M.D. of Houston
Order Number: DWC-120056
Date of Order:  4/11/2012
Order Final In:   April
Action Taken:  Fined $1,500; Must attend compliance training for doctors and medical office staff
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Houston Independent School District of Houston
Order Number: DWC-120050
Date of Order:  4/2/2012
Order Final In:   April
Action Taken:  Fined $6,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to notify Texas Department of Insurance - Division of Workers Compensation TDI-DWC and injured employee of actions taken on claim


Juanita's Angels Home Healthcare L.L.C. of Pharr
Order Number: DWC-120057
Date of Order:  4/18/2012
Order Final In:   April
Action Taken:  Fined $1,000
Violation:  Failed to timely provide TDI-DWC with requested information about workers' compensation coverage status; Failed to comply with Texas Department of Insurance - Division of Workers Compensation TDI-DWC order


King's Daughters Clinic of Temple
Order Number: DWC-120059
Date of Order:  4/18/2012
Order Final In:   April
Action Taken:  Fined $1,000 
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


One Call Medical, Inc. of Parsippany, NJ
Order Number: DWC-120065
Date of Order:  4/30/2012
Order Final In:   April
Action Taken:  Fined $18,500
Violation:  Failed to provide TDI-DWC with accurate list of insurance carriers in informal network; Failed to timely provide information to Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Prudential Healthcare Services, Inc. of Arlington
Order Number: DWC-120066
Date of Order:  4/30/2012
Order Final In:   April
Action Taken:  Fined $1,500
Violation:  Failed to timely provide TDi-DWC with requested information about workers' compensation coverage status; Failed to comply with Texas Department of Insurance - Division of Workers Compensation TDI-DWC order


Royal Care, Inc. of Houston
Order Number: DWC-120067
Date of Order:  4/30/2012
Order Final In:   April
Action Taken:  Fined $1,000
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Schwartz, David P., D.O. of Pasadena
Order Number: DWC-120069
Date of Order:  4/30/2012
Order Final In:   April
Action Taken:  Removed from Designated Doctor List
Violation:  Failed to perform a required designated doctor examination; Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Select Physical Therapy of Mechanicsburg, PA
Order Number: DWC-120060
Date of Order:  4/18/2012
Order Final In:   April
Action Taken:  Fined $2,000 
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


University General Hospital, L.P. of Houston
Order Number: DWC-120064
Date of Order:  4/27/2012
Order Final In:   April
Action Taken:  Fined $1,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Wausau Underwriters Insurance Company of Boston, MA
Order Number: DWC-120068
Date of Order:  4/30/2012
Order Final In:   April
Action Taken:  Fined $3,500
Violation:  Failed to accurately submit medical bill and payment data


Winn, Mitchell H., O.T.R. of Plano
Order Number: DWC-120063
Date of Order:  4/27/2012
Order Final In:   April
Action Taken:  Must attend functional capacity examination training
Violation:  Failed to properly complete and document a functional capacity examination


Affordable Elder Care Inc. of Mesquite
Order Number: DWC-120040
Date of Order:  3/6/2012
Order Final In:   March
Action Taken:  Fined $700
Violation:  Failed to timely comply with Texas Department of Insurance - Division of Workers Compensation TDI-DWC request for information on workers' compensation coverage status


Capitol Emergency Associates PA of Oklahoma City, OK
Order Number: DWC-120049
Date of Order:  3/29/2012
Order Final In:   March
Action Taken:  Fined $1,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


City of McAllen of McAllen, TX
Order Number: DWC-120036
Date of Order:  3/1/2012
Order Final In:   March
Action Taken:  Fined $4,000
Violation:  Failed to timely pay a Texas Department of Insurance - Division of Workers Compensation TDI-DWC ordered advance; Failed to comply with TDI-DWC order


Dallas National Insurance Company, A Texas Stock Insurance Co. of Dallas
Order Number: DWC-120045
Date of Order:  3/12/2012
Order Final In:   March
Action Taken:  Fined $19,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by Electronic Data Interchange; Failed to timely pay medical bill or to pay medical bill according to Texas Department of Insurance - Division of Workers Compensation TDI-DWC Medical Fee Guidelines; Failed to timely file accident prevention services annual report

Insurance Company of the State of Pennsylvania of New York, NY
Order Number: DWC-120046
Date of Order:  3/16/2012
Order Final In:   March
Action Taken:  Fined $3,900
Violation:  Failed to accurately report claims information to Texas Department of Insurance - Division of Workers Compensation TDI-DWC; Failed to timely schedule required medical examination; Failed to timely pay death benefits


Niemirowski, George J., M.D. of Arlington
Order Number: DWC-120044
Date of Order:  3/12/2012
Order Final In:   March
Action Taken:  Fined $4,500
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Pharr-San Juan-Alamo Independent School District of Pharr
Order Number: DWC-120038
Date of Order:  3/2/2012
Order Final In:   March
Action Taken:  Fined $7,500
Violation:  Failed to timely pay medical bill or to pay medical bill according to Texas Department of Insurance - Division of Workers Compensation TDI-DWC Medical Fee Guidelines; Failed to accurately submit medical bill and payment data


Wausau Business Insurance Company of Irving
Order Number: DWC-120039
Date of Order:  3/2/2012
Order Final In:   March
Action Taken:  Fined $12,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to notify Texas Department of Insurance - Division of Workers Compensation TDI-DWC and injured employee of actions taken on a claim


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-120041
Date of Order:  3/8/2012
Order Final In:   March
Action Taken:  Fined $4,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely pay medical bill or to pay medical bill according to Texas Department of Insurance - Division of Workers Compensation TDI-DWC Medical Fee Guidelines


Assist Med Inc. of Houston
Order Number: DWC-120035
Date of Order:  2/23/2012
Order Final In:   February
Action Taken:  Fined $1,000
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Hartford Insurance Company of the Midwest of Hartford, CT
Order Number: DWC-120032
Date of Order:  2/16/2012
Order Final In:   February
Action Taken:  Fined $13,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to notify Texas Department of Insurance - Division of Workers Compensation TDI-DWC and injured employee of actions taken on a claim


Katy Urgent Care Center of Katy
Order Number: DWC-120028
Date of Order:  2/14/2012
Order Final In:   February
Action Taken:  Fined $1,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


McWatt, Gordon G., D.O. of Fort Worth
Order Number: DWC-120020
Date of Order:  2/1/2012
Order Final In:   February
Action Taken:  Must attend workers' compensation health provider training
Violation:  (The order was not a Consent Order, SOAH issued a Proposal for Decision and Decision in Docket No. 454-09-5313.C1; the Commissioner issued an Official Order) Failed to maintain required documentation; Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records. Both Orders were appealed and are pending in district court.


New Hampshire Insurance Company of New York, NY
Order Number: DWC-120027
Date of Order:  2/14/2012
Order Final In:   February
Action Taken:  Fined $16,000
Violation:  Failed to timely pay medical bill or to pay medical bill according to TDI-DWC Medical Fee Guidelines; Failed to timely reimburse injured employee for travel expenses; Failed to timely notify  Texas Department of Insurance - Division of Workers Compensation TDI-DWC of death benefit payments


Ninala, Ranil Ronald M.D. of Dallas
Order Number: DWC-120029
Date of Order:  2/14/2012
Order Final In:   February
Action Taken:  Fined $3,000
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Praetorian Insurance Company of Sun Prairie, WI
Order Number: DWC-120031
Date of Order:  2/16/2012
Order Final In:   February
Action Taken:  Fined $14,000
Violation:  Failed to provide on-site visit or other appropriate services to policyholders with $25,000 or more in premium; Failed to provide written solicitation of comments from each policyholder at least every 12 months


Travelers Property Casualty Company of America of Hartford, CT
Order Number: DWC-12-0034
Date of Order:  2/22/2012
Order Final In:   February
Action Taken:  Fined $25,000
Violation:  Failed to process claims promptly in a reasonable and prudent manner; Failed to timely pay death benefits to eligible beneficiaries; Failed to timely notify Texas Department of Insurance - Division of Workers Compensation TDI-DWC electronically of first payment of disability death benefits


Wausau Underwriters Insurance Company of Wausau, WI
Order Number: DWC-120030
Date of Order:  2/14/2012
Order Final In:   February
Action Taken:  Fined $5,000
Violation:  Failed to timely pay income benefits to injured employee


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-12-0008
Date of Order:  1/4/2012
Order Final In:   January
Action Taken:  Fined $8,500
Violation:  Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC


ACIG Insurance Company of Dallas
Order Number: DWC-12-0007
Date of Order:  1/4/2012
Order Final In:   January
Action Taken:  Fined $5,500
Violation:  Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to accurately submit medical bill and payment data


American Home Assurance Company of New York, NY
Order Number: DWC-12-0018
Date of Order:  1/30/2012
Order Final In:   January
Action Taken:  Fined $1,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely and accurately submit benefit data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC via Electronic Data Interchange


American Zurich Insurance Company of Schaumberg, IL
Order Number: DWC-12-0006
Date of Order:  1/4/2012
Order Final In:   January
Action Taken:  Fined $27,500
Violation:  Retrospectively reviewed medical necessity of preauthorized medical service or treatment; Failed to timely pay income benefits to injured employee; Failed to timely act on request for reconsideration of a medical bill; Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Benson, Leslie Wayne M.D. of Waco
Order Number: DWC-12-0019
Date of Order:  1/30/2012
Order Final In:   January
Action Taken:  Designated Doctor appointments restricted to one location for one year
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records; Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Dallas Lighthouse for the Blind, Inc. of Dallas
Order Number: DWC-120099
Date of Order:  6/18/2012
Order Final In:   January
Action Taken:  Fined $500
Violation:  ??


Employers Insurance Company of Wausau of Wausau, WI
Order Number: DWC-12-0004
Date of Order:  1/4/2012
Order Final In:   January
Action Taken:  Fined $15,000
Violation:  Failed to accurately submit medical bill and payment data


Fidelity & Guarantee Insurance Company of Austin
Order Number: DWC-12-0010
Date of Order:  1/9/2012
Order Final In:   January
Action Taken:  Fined $8,000
Violation:  Failed to timely pay income benefits to injured employee


Hartford Underwriters Insurance Company of Hartford, CN
Order Number: DWC-12-0005
Date of Order:  1/4/2012
Order Final In:   January
Action Taken:  Fined $5,000
Violation:  Failed to process claims promptly in a reasonable and prudent manner


Illinois National Insurance Company of New York, NY
Order Number: DWC-12-0015
Date of Order:  1/30/2012
Order Final In:   January
Action Taken:  Fined $8,900
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely and accurately submit benefit data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC via Electronic Data


Liberty Insurance Corporation of Boston, MA
Order Number: DWC-12-0016
Date of Order:  1/30/2012
Order Final In:   January
Action Taken:  Fined $5,000
Violation:  Failed to timely pay income benefits to injured employee


Liberty Mutual Insurance Company of Boston, MA
Order Number: DWC-12-0002
Date of Order:  1/4/2012
Order Final In:   January
Action Taken:  Fined $16,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately submit medical bill and payment data


Mirkin, Dana Brian M.D. of Austin
Order Number: DWC-12-0001
Date of Order:  1/4/2012
Order Final In:   January
Action Taken:  Fined $4,000; Must attend compliance training for doctors and medical office staff
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Oakley, Carol Jane D.C. of Houston
Order Number: DWC-12-0017
Date of Order:  1/30/2012
Order Final In:   January
Action Taken:  Fined $1,000; Must not participate in workers' compensation system as health care provider for one year
Violation:  Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Pharr San Juan Alamo Independent School District of Pharr
Order Number: DWC-12-0003
Date of Order:  1/4/2012
Order Final In:   January
Action Taken:  Fined $8,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely notify Texas Department of Insurance - Division of Workers Compensation TDI-DWC and injured employee of actions taken on a claim; Failed to accurately submit medical bill and payment data


Swartworth, William M.D. of Tyler
Order Number: DWC-12-0013
Date of Order:  1/25/2012
Order Final In:   January
Action Taken:  Fined $2,000
Violation:  Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Texas Mutual Insurance Company of Austin
Order Number: DWC-12-0011
Date of Order:  1/17/2012
Order Final In:   January
Action Taken:  Fined $12,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely report payment of indemnity benefits


Wausau Business Insurance Company of Boston, MA
Order Number: DWC-12-0009
Date of Order:  1/9/2012
Order Final In:   January
Action Taken:  Fined $16,000
Violation:  Failed to accurately submit medical bill and payment data


2011

 

AAA Cooper Transportation of Dothan, AL
Order Number: DWC-11-0115
Date of Order:  12/6/2011
Order Final In:   December
Action Taken:  Fined $9,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately submit medical bill and payment data


Castlepoint National Insurance Company of New York, NY
Order Number: DWC-11-0125
Date of Order:  12/22/2011
Order Final In:   December
Action Taken:  Fined $10,000 with a dollar-for-dollar reduction of up to $4,650 for refunds paid to policyholders
Violation:  Improperly charged policyholders for providing accident prevention services


Dallas National Insurance Company, A Texas Stock Insurance Company of Dallas
Order Number: DWC-11-0119
Date of Order:  12/15/2011
Order Final In:   December
Action Taken:  Fined $100,000
Violation:  Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to timely pay income benefits to injured employee


El Paso County of El Paso
Order Number: DWC-11-0120
Date of Order:  12/16/2011
Order Final In:   December
Action Taken:  Fined $2,500
Violation:  Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Ennis, Gregory P., M.D. of Irving
Order Number: DWC-11-0121
Date of Order:  12/16/2011
Order Final In:   December
Action Taken:  Fined $1,500; Must attend compliance training for doctors and medical office staff
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


McWatt, Gordon G., D.O. of Aledo
Order Number: DWC-11-0124
Date of Order:  8/5/2011
Order Final In:   December
Action Taken:  Fined $15,000
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Nguyen, Quoc Thai D.C. of Houston
Order Number: DWC-11-0127
Date of Order:  12/22/2011
Order Final In:   December
Action Taken:  Fined $2,500; Must complete approved continuing education hours
Violation:  Failed to practice medicine or provide health care consistent with public health, safety and welfare


Orlov, Alexander D.O. of Lufkin
Order Number: DWC-11-0116
Date of Order:  12/9/2011
Order Final In:   December
Action Taken:  Removed from workers' compensation system as health care practitioner and deleted from Designated Doctor List.
Violation:  Criminal offense


Texas Mutual Insurance Company of Austin
Order Number: DWC-11-0114
Date of Order:  12/6/2011
Order Final In:   December
Action Taken:  Fined $10,000
Violation:  Failed to timely pay an order to pay attorney's fees; Failed to comply with a Texas Department of Insurance - Division of Workers Compensation TDI-DWC order; Failed to provide opposing party a letter of clarification


Tower National Insurance Company of New York, NY
Order Number: DWC-11-0126
Date of Order:  12/22/2012
Order Final In:   December
Action Taken:  Fined $36,000 with a dollar-for-dollar reduction of up to $30,200 for refunds paid to policyholders
Violation:  Improperly charged policyholders for providing accident prevention services


Dallas Independent School District of Dallas
Order Number: DWC-11-0111
Date of Order:  11/3/2011
Order Final In:   November
Action Taken:  Fined $3,500
Violation:  Failed to accurately submit medical bill and payment data


Dallas National Insurance Company, A Texas Stock Insurance Company of Dallas
Order Number: DWC-11-0110
Date of Order:  11/3/2011
Order Final In:   November
Action Taken:  Fined $20,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to pay an order awarding benefits; Failed to comply with order or decision of Commissioner; Failed to timely pay attorney's fees


Hidalgo County of Edinburg
Order Number: DWC-11-0113
Date of Order:  11/3/2011
Order Final In:   November
Action Taken:  Fined $7,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely notify Texas Department of Insurance - Division of Workers Compensation TDI-DWC on actions taken on a claim


Lubbock Heritage Hospital, L.L.C. d/b/a Grace Medical Center of Lubbock
Order Number: DWC-11-0105
Date of Order:  11/3/2011
Order Final In:   November
Action Taken:  Fined $3,000
Violation:  Improperly billed an injured employee for workers’ compensation medical services provided


McShane, Ricky Michael D.O. of Deer Park
Order Number: DWC-11-0107
Date of Order:  11/3/2011
Order Final In:   November
Action Taken:  Fined $10,000; Must attend compliance training for doctors and medical office staff
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records; Failed to timely file letter of clarification


National Interstate Insurance Company of Richfield, OH
Order Number: DWC-11-0106
Date of Order:  11/3/2012
Order Final In:   November
Action Taken:  Fined $3,000
Violation:  Failed to timely file Accident Prevention Services Report; Failed to timely provide investigation documentation relating to compensability of a death


Netherlands Insurance Company of Boston, MA
Order Number: DWC-11-0112
Date of Order:  11/3/2011
Order Final In:   November
Action Taken:  Fined $8,500
Violation:  Failed to timely report termination of death benefits


Texas Builders Insurance Company of Austin
Order Number: DWC-11-0109
Date of Order:  11/3/2011
Order Final In:   November
Action Taken:  Fined $25,000
Violation:  Failed to maintain or provide accident prevention services and facilities; Failed to provide mandatory on-site visits to certain policyholders


Ullico Casualty Company of Washington, D.C.
Order Number: DWC-110108
Date of Order:  11/3/2011
Order Final In:   November
Action Taken:  Fined $8,500
Violation:  Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to timely submit medical bill and payment data to the Division


Accident Fund Insurance Company of America of Lansing, MI
Order Number: DWC-11-0089
Date of Order:  9/23/2011
Order Final In:   September
Action Taken:  Fined $8,000
Violation:  Failed to accurately report benefit data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Chubb Indemnity Insurance Company of Warren, NJ
Order Number: DWC-11-0092
Date of Order:  9/23/2011
Order Final In:   September
Action Taken:  Fined $24,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately report benefit data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC


City of Corpus Christi of Corpus Christi
Order Number: DWC-11-0085
Date of Order:  9/8/2011
Order Final In:   September
Action Taken:  Fined $1,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately submit medical bill and payment data


Clarendon National Insurance Company of New York, NY
Order Number: DWC-11-0090
Date of Order:  9/23/2011
Order Final In:   September
Action Taken:  Fined $26,500
Violation:  Failed to accurately and timely report benefit data to TDI-DWC; Failed to timely pay medical bill or to pay medical bill according to Texas Department of Insurance - Division of Workers Compensation TDI-DWC Medical Fee Guidelines


Corpus Christi Independent School District of Corpus Christi
Order Number: DWC-11-0087
Date of Order:  9/8/2011
Order Final In:   September
Action Taken:  Fined $15,000
Violation:  Failed to accurately report electronic billing data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Federal Insurance Company of Warren, NJ
Order Number: DWC-11-0093
Date of Order:  9/23/2011
Order Final In:   September
Action Taken:  Fined $17,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely pay medical bill


Gottesman, Jerome G. of Houston
Order Number: DWC-11-0091
Date of Order:  9/23/2011
Order Final In:   September
Action Taken:  Fined $1,000
Violation:  Breached a Texas Department of Insurance - Division of Workers Compensation TDI-DWC approved agreement


Lewis, Jacques Brandon M.D. of Uvalde
Order Number: DWC-11-0084
Date of Order:  9/8/2011
Order Final In:   September
Action Taken:  Fined $2,000; Must attend physician training
Violation:  Failed to provide sufficient documentation to support conducting problem-oriented physical examinations


Wal-Mart Associates, Inc. of Bentonville, AR
Order Number: DWC-11-0086
Date of Order:  9/8/2011
Order Final In:   September
Action Taken:  Fined $23,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely respond to a request for reconsideration; Failed to pay fees according to Texas Department of Insurance - Division of Workers Compensation TDI-DWC Medical Fee Guidelines


Cherokee Insurance Company of Warren, MI
Order Number: DWC-11-0078
Date of Order:  8/18/2011
Order Final In:   August
Action Taken:  Fined $14,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately submit medical bill and payment data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC


City of Houston of Houston
Order Number: DWC-11-0077
Date of Order:  8/18/2011
Order Final In:   August
Action Taken:  Fined $5,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately report benefit data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC or accurately submit benefit data by electronic data interchange


Gray Insurance Company of Metairle, LA
Order Number: DWC-11-0075
Date of Order:  8/5/2011
Order Final In:   August
Action Taken:  Fined $5,000; Must provide compliance plan for timely processing of medical bills
Violation:  Failed to accurately submit medical bill and payment data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC; Failed to timely pay income benefits to injured employee


Texas Political Subdivisions Joint Self Insurance Funds of Dallas
Order Number: DWC-11-0076
Date of Order:  8/8/2011
Order Final In:   August
Action Taken:  Fined $2,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Vista Hospital of Dallas, LLP, and Vista Community Medical Center, LLP of Dallas
Order Number: DWC-11-0082
Date of Order:  9/15/2011
Order Final In:   August
Action Taken:  Fined $18,000
Violation:  (The order was not a Consent Order, SOAH issued a Decision and Order in Docket No. 454-10-6056) Submitted charges for services not furnished; Violated TDI-DWC fee and treatment guidelines; Failed to comply with requirements for medical billing; Failed to comply with a Commissioner rule. The order was appealed to District Court and reversed and remanded back to SOAH.


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-11-0068
Date of Order:  7/12/2011
Order Final In:   July
Action Taken:  Fined $40,000
Violation:  Failed to comply with order of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC; Failed to timely pay a medical bill; Failed to pay for preauthorized medical services


Connecticut Indemnity Company of Addison, TX
Order Number: DWC-11-0072
Date of Order:  7/22/2011
Order Final In:   July
Action Taken:  Fined $2,500
Violation:  Failed to pay an order awarding benefits; Failed to comply with an order of the Commissioner or  Texas Department of Insurance - Division of Workers Compensation TDI-DWC


EBI, LLC of Parisippany, NJ
Order Number: DWC-11-0071
Date of Order:  7/22/2011
Order Final In:   July
Action Taken:  Fined $2,500
Violation:  Improperly billed injured employee for workers' compensation medical services provided


Valdez, Anthony Francis M.D. of El Paso
Order Number: DWC-11-0070
Date of Order:  7/22/2011
Order Final In:   July
Action Taken:  Ordered to cease and desist from participating in workers' compensation system
Violation:  Provided health care and received remuneration for services to injured employees after being denied admission to Approve Doctors List


America First Lloyds Insurance Company of Richardson
Order Number: DWC-11-0062
Date of Order:  6/17/2011
Order Final In:   June
Action Taken:  Fined $9,000
Violation:  Failed to accurately report medical bill and payment data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC


FedEx Freight Inc. of Memphis, TN
Order Number: DWC-11-0067
Date of Order:  6/24/2011
Order Final In:   June
Action Taken:  Fined $7,050
Violation:  Failed to accurately report medical bill and payment data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Netherlands Insurance Company of Boston, MA
Order Number: DWC-11-0066
Date of Order:  6/24/2011
Order Final In:   June
Action Taken:  Fined $2,500
Violation:  Failed to accurately submit pay income benefits to injured employee


American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-11-0057
Date of Order:  5/6/2011
Order Final In:   May
Action Taken:  Fined $9,000
Violation:  Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to accurately submit medical bill and payment data ; Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC; Failed to timely reimburse injured employee for travel expenses


Gibbons, Raymond Robert M.D. of Dallas
Order Number: DWC-11-0055
Date of Order:  5/6/2011
Order Final In:   May
Action Taken:  Must limit injuries, illnesses and body areas evaluated; Must attend compliance training for doctors and medical office staff
Violation:  Failed to assign Impairment Ratings in accordance with American Medical Association Guides


Hanover Insurance Company of Worcester, MA
Order Number: DWC-11-0053
Date of Order:  5/6/2011
Order Final In:   May
Action Taken:  Fined $15,000
Violation:  Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC; Failed to accurately submit medical bill and payment data


Hartford Casualty Insurance Corporation of Hartford, CT
Order Number: DWC-11-0060
Date of Order:  5/16/2011
Order Final In:   May
Action Taken:  Fined $5,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely pay attorney fees


Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-11-0054
Date of Order:  5/6/2011
Order Final In:   May
Action Taken:  Fined $15,500
Violation:  Failed to comply with order or decision of Commissioner or Texas Department of Insurance - Division of Workers Compensation TDI-DWC; Failed to timely pay income benefits to injured employee


New Hampshire Insurance Company of New York, NY
Order Number: DWC-11-0056
Date of Order:  5/6/2011
Order Final In:   May
Action Taken:  Fined $5,000
Violation:  Failed to timely pay income benefits to injured employee


Spine & Orthopaedic Institute of Boston, MA
Order Number: DWC-11-0059
Date of Order:  5/6/2011
Order Final In:   May
Action Taken:  Fined $1,500
Violation:  Failed to properly respond to insurance carriers request for refund


Texas Hospital Insurance Exchange of Austin
Order Number: DWC-11-0058
Date of Order:  5/6/2011
Order Final In:   May
Action Taken:  Fined $5,000
Violation:  Failed to timely submit medical bill and payment data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC


XL Insurance America Inc. of Exton, PA
Order Number: DWC-11-0061
Date of Order:  5/27/2011
Order Final In:   May
Action Taken:  Fined $7,000
Violation:  Failed to accurately submit medical bill and payment data


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-11-0052
Date of Order:  5/6/2011
Order Final In:   May
Action Taken:  Fined $10,000
Violation:  Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to sufficiently explain reasons for the reduction or denial of payment for health care services; Failed to pay for preauthorized medical services


Dodge, William David M.D. of Dallas
Order Number: DWC-11-0046
Date of Order:  4/12/2011
Order Final In:   April
Action Taken:  Fined $4,000; Must attend compliance training for doctors and medical office staff
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Downey, Sara D.C. of Grand Prairie
Order Number: DWC-11-0047
Date of Order:  4/25/2011
Order Final In:   April
Action Taken:  Take an AADEP-sponsored medical examination and submit score to Division; Designated Doctor examinations will be monitored provided by AADEP; Must submit Designated Doctor examinations for review
Violation:  Failed to provide an explanation for the date of Maximum Medical Improvement (MMI); Failed to assign an impairment rating in accordance with applicable guidelines


East Texas Educational Insurance Association of Tyler
Order Number: DWC-11-0049
Date of Order:  4/25/2011
Order Final In:   April
Action Taken:  Fined $7,000
Violation:  Failed to comply with an order or decision of the Commissioner


Rose, James Keith M.D. of Corpus Christi
Order Number: DWC-11-0045
Date of Order:  4/12/2011
Order Final In:   April
Action Taken:  Fined $1,000; Must attend compliance training for doctors and medical staff
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Southwest General Emergency Physicians, PLLC of Hollywood, FL
Order Number: DWC-11-0048
Date of Order:  4/25/2011
Order Final In:   April
Action Taken:  Fined $1,000
Violation:  Improperly billed an injured employee for workers’ compensation medical services provided


Tarrant County College District of Fort Worth
Order Number: DWC-11-0050
Date of Order:  4/25/2011
Order Final In:   April
Action Taken:  Fined $3,500
Violation:  Reported inaccurate billing data to Division


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-11-0028
Date of Order:  3/3/2011
Order Final In:   March
Action Taken:  Nunc Pro Tunc
Violation:  Please see Order Number DWC 11-0011


American Home Assurance Company of New York NY
Order Number: DWC-11-0032
Date of Order:  3/3/2011
Order Final In:   March
Action Taken:  Fined $11,000
Violation:  Failed to pay for preauthorized medical services; Failed to timely respond to an injured employee's request for reimbursement of travel expenses


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-110030
Date of Order:  3/3/2011
Order Final In:   March
Action Taken:  Fined $4,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely pay medical bill; Failed to timely act on request for reconsideration of a medical bill


Begia, Bruce C., M.D. of San Antonio
Order Number: DWC-110040
Date of Order:  3/11/2011
Order Final In:   March
Action Taken:  Fined $1,000; Must attend compliance training for doctors and medical staff
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Bumagin, Michael S. M.D. of Fort Worth
Order Number: DWC-110027
Date of Order:  3/3/2011
Order Final In:   March
Action Taken:  Removed from Designated Doctor List; Maximum Medical Improvement and Impairment Rating certifications revoked
Violation:  Failed to assign Impairment Ratings in accordance with the American Medical Association Guides to Permanent Impairment


Crockett, James D.O. of Marlin
Order Number: DWC-110043
Date of Order:  3/24/2011
Order Final In:   March
Action Taken:  Removed from participation in workers' compensation system as health care provider for 10 years
Violation:  Provided diagnoses and treatments found to be improper, unfair and/or unreasonable and not supported by documentation and/or physical examination of injured employee


Dallas National Insurance Company, A Texas Stock Insurance Company of Dallas
Order Number: DWC-110042
Date of Order:  3/22/2011
Order Final In:   March
Action Taken:  Fined $9,000
Violation:  Failed to pay for preauthorized medical services; Failed to timely pay income benefits to injured employee


Davis, Carl Cuthbert Jr., M.D. of Houston
Order Number: DWC-110031
Date of Order:  3/3/2011
Order Final In:   March
Action Taken:  Fined $1,250; Suspended from Designated Doctor's List of 90 days; Must attend compliance training for doctors and medical staff
Violation:  Failed to timely file letter of clarification; Failed to timely file and/or accurately complete  Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Hartford Fire Insurance Company of Hartford, CT
Order Number: DWC-110035
Date of Order:  3/3/2011
Order Final In:   March
Action Taken:  Fined $5,000
Violation:  Failed to reasonably and prudently process claims ; Failed to provide written notification of claims experience; Failed to provide written notification of loss analysis; Failed to provide mandatory on-site visit to policyholders


Hartford Insurance Company of the Midwest of Hartford, CT
Order Number: DWC-110034
Date of Order:  3/3/2011
Order Final In:   March
Action Taken:  Fined $4,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to provide written notification of claims experience


Horoda, Michael Johnathan, M.D. of Fort Worth
Order Number: DWC-110029
Date of Order:  3/3/2011
Order Final In:   March
Action Taken:  Fined $3,000
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Houston Northwest Emergency Specialists, PLLC of Houston
Order Number: DWC-110039
Date of Order:  3/7/2011
Order Final In:   March
Action Taken:  Fined $4,000
Violation:  Improperly billed an injured employee for workers’ compensation medical services provided


Moczygemba, Roger M., M.D. of San Antonio
Order Number: DWC-110041
Date of Order:  3/22/2011
Order Final In:   March
Action Taken:  Fined $3,000; Must attend compliance training for doctors and medical staff
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Osborne, William (Phillip) M.D. of Houston
Order Number: DWC-110044
Date of Order:  3/24/2011
Order Final In:   March
Action Taken:  Fined $4,500; Must attend compliance training for doctors and medical staff
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


TASB Risk Management Fund of Austin
Order Number: DWC-110036
Date of Order:  3/3/2011
Order Final In:   March
Action Taken:  Fined $5,000
Violation:  Failed to timely pay income benefits to injured employee


Transportation Insurance Company of Chicago, IL
Order Number: DWC-110033
Date of Order:  3/3/2011
Order Final In:   March
Action Taken:  Fined $10,000
Violation:  Retrospectively reviewed medical necessity of preauthorized medical service or treatment; Failed to pay for preauthorized medical services


Wan, Christine Wyman M.D. of Odessa
Order Number: DWC-110037
Date of Order:  3/3/2011
Order Final In:   March
Action Taken:  Fined $1,000; Must attend compliance training for doctors and medical staff
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Wolski, Edward, M.D. DBA Wol+Med of Denton
Order Number: DWC-110038
Date of Order:  3/7/2011
Order Final In:   March
Action Taken:  Fined $5,000
Violation:  Filed unwarranted complaints against system participants


Anderson, C. Lynn M.D. of Brownsville
Order Number: DWC-11-0022
Date of Order:  2/11/2011
Order Final In:   February
Action Taken:  Fined $6,000; Must attend compliance training for doctors and medical office staff
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Liberty Insurance Corporation of Boston, MA
Order Number: DWC-11-0021
Date of Order:  2/11/2011
Order Final In:   February
Action Taken:  Fined $1,000
Violation:  Failed to timely pay income benefits to injured employee


Liberty Mutual Insurance Company of Boston, MA
Order Number: DWC-11-0023
Date of Order:  2/21/2011
Order Final In:   February
Action Taken:  Fined $3,000
Violation:  Failed to comply with Commissioner’s order to pay advance temporary income benefits


LM Insurance Corporation of Boston, MA
Order Number: DWC-110020
Date of Order:  2/11/2011
Order Final In:   February
Action Taken:  Fined $18,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to pay correct income benefit amount; Failed to timely pay medical bill


Memorial Hermann Hospital System d/b/a Memorial Hermann Katy Hospital of Katy
Order Number: DWC-11-0024
Date of Order:  2/21/2011
Order Final In:   February
Action Taken:  Fined $6,000
Violation:  Improperly billed an injured employee for workers’ compensation medical services provided


Methodist Hospital of San Antonio
Order Number: DWC-11-0025
Date of Order:  2/21/2011
Order Final In:   February
Action Taken:  Fined $6,000
Violation:  Improperly billed an injured employee for workers’ compensation medical services provided


Rosenstein, Jacob M.D. of Arlington
Order Number: DWC-110018
Date of Order:  2/3/2011
Order Final In:   February
Action Taken:  Consent Order
Violation:  Relating to quality of health care provided to injured employees in workers' compensation system


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-110011
Date of Order:  1/26/2011
Order Final In:   January
Action Taken:  Fined $48,000
Violation:  Failed to comply with TDI-DWC or Commissioner Order; Failed to timely pay income benefits to injured employee; Failed to timely act on request for reconsideration of a medical bill; Failed to accurately report benefit data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC or accurately submit benefit data by electronic data interchange 
________________________________________


American Casualty Company of Reading, Pennsylvania of Chicago, IL
Order Number: DWC-110005
Date of Order:  1/10/2011
Order Final In:   January
Action Taken:  Fined $25,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to comply with TDI-DWC or Commissioner Order; Failed to pay medical bills according to TDI-DWC Medical Fee Guidelines; Failed to accurately report benefit data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC or accurately submit benefit data by electronic data interchange; Failed to timely act on request for reconsideration of a medical bill; Failed to pay for preauthorized medical services


Chen, Dean M.D. of Austin
Order Number: DWC-110004
Date of Order:  1/10/2011
Order Final In:   January
Action Taken:  Fined $2,000; Must attend compliance training for doctors and medical office staff
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Christus Santa Rosa Hospital of San Antonio
Order Number: DWC-110001
Date of Order:  1/10/2011
Order Final In:   January
Action Taken:  Fined $6,000
Violation:  Improperly billed an injured employee for workers’ compensation medical services provided


CorVel Healthcare Corporation of Addison
Order Number: DWC-110007
Date of Order:  1/10/2011
Order Final In:   January
Action Taken:  Fined $7,000
Violation:  Failed to provide TDI-DWC with list of insurance carriers with whom the network contracted and/or timely report changes to list to Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-110016
Date of Order:  1/28/2011
Order Final In:   January
Action Taken:  Fined $68,000
Violation:  Failed to comply with TDI-DWC or Commissioner Order; Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to sufficiently explain the reasons for the reduction or denial of payment for health care services to the injured employee; Failed to timely pay income benefits to injured employee; Failed to pay for preauthorized medical services


Jolivet, David Anthony M.D. of Houston
Order Number: DWC-110012
Date of Order:  1/26/2011
Order Final In:   January
Action Taken:  Fined $4,000; Must attend compliance training for doctors and medical office staff
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Knoll, Victoria D., M.D. of Plano
Order Number: DWC-11-0002
Date of Order:  1/10/2011
Order Final In:   January
Action Taken:  Fined $1,000; 
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Lee, Walter M.D. of Houston
Order Number: DWC-110015
Date of Order:  1/28/2011
Order Final In:   January
Action Taken:  Fined $8,000; Must attend compliance training for doctors and medical office staff
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Lumbermen's Underwriting Alliance of Boca Raton, FL
Order Number: DWC-110017
Date of Order:  1/28/2011
Order Final In:   January
Action Taken:  Fined $4,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely comply with an order to pay income benefits


Metropolitan Methodist Hospital of Cincinnati, OH
Order Number: DWC-110014
Date of Order:  1/26/2011
Order Final In:   January
Action Taken:  Fined $10,000
Violation:  Improperly billed an injured employee for workers’ compensation medical services provided


Puig, Louis Frank III, M.D. of Pasadena
Order Number: DWC-110013
Date of Order:  1/26/2011
Order Final In:   January
Action Taken:  Fined $2,000; Must attend compliance training for doctors and medical office staff
Violation:  Failed to timely file and/or accurately complete Texas Department of Insurance - Division of Workers Compensation TDI-DWC forms, reports or records


Quest Diagnostics, Inc. of Collegeville, PA
Order Number: DWC-110010
Date of Order:  1/26/2011
Order Final In:   January
Action Taken:  Fined $5,000
Violation:  Improperly billed an injured employee for workers’ compensation medical services provided


XL Specialty Insurance Company of Exton, PA
Order Number: DWC-110003
Date of Order:  1/10/2011
Order Final In:   January
Action Taken:  Fined $25,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately report benefit data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC or accurately submit benefit data by electronic data interchange; Failed to timely pay attorney fees



2010

 

American Guarantee & Liability Insurance Company of Schaumburg, IL
Order Number: DWC-10-0126
Date of Order:  12/3/2010
Order Final In:   December
Action Taken:  Fined $30,000
Violation:  Failed to comply with decision or order of Commissioner; 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 timely file DWC Form-69; Failed to file DWC Form-69 with the carrier via facsimile or electronic transmission


Continental Casualty Company of Chicago, IL
Order Number: DWC-10-0136
Date of Order:  12/13/2010
Order Final In:   December
Action Taken:  Fined $7,000
Violation:  Failed to explain 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 submit compliance report
Violation:  Failed to timely file DWC Form-69; 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, CT
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, AL
Order Number: DWC-10-0118
Date of Order:  12/3/2010
Order Final In:   December
Action Taken:  Fined $5,000
Violation:  Failed to comply with 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, NY
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


Old Republic Insurance Company of Chicago, IL
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 respond to a request for reconsideration; Failed to pay for preauthorized 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; 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:  12/3/2010
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, IL
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


Travelers Indemnity Company of Hartford, CT
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 explain reduction or denial of payment for medical services to injured employee, health care provider and Division; Failed to timely initiate TIBs; Failed to pay for preauthorized medical services


Travelers Indemnity Company of Connecticut of Hartford, CT
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 explain reduction or denial of payment for health care services to injured employee, health care provider and Division; Failed to attend contested case hearing; Failed to timely initiate benefits; Failed to comply with decison or order of Commissioner


Travelers Property Casualty Company of America of Hartford, CT
Order Number: DWC-10-0140
Date of Order:  12/13/2010
Order Final In:   December
Action Taken:  Fined $20,000
Violation:  Failed to pay order awarding benefits; Unreasonably disputed the necessity of health care; Failed to pay for preauthorized medical services; Failed to explain reduction or denial of payment for medical services to injured employee, health care provider and Division


Twin City Fire Insurance Company of Hartford, CT
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:  Filed to timely file the Accident Prevention Services Report


American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-100100
Date of Order:  11/8/2010
Order Final In:   November
Action Taken:  Fined $32,000
Violation:  Failed to timely pay TIBs; Failed to pay for preauthorized treatments/services; Failed to timely process medical bills; Failed to visit the insured within three days of notification and/or knowledge of a fatality


Carrion, George M.D. of San Antonio
Order Number: DWC-100113
Date of Order:  11/16/2010
Order Final In:   November
Action Taken:  Fined $12,000
Violation:  Failed to file DWC Form-69 in a timely manner; Failed to file DWC Form-69 with the carrier via facsimile or electronic submission; Failed to properly assign maximum medical improvement


City of San Antonio of San Antonio
Order Number: DWC-100094
Date of Order:  11/5/2010
Order Final In:   November
Action Taken:  Fined $48,000; Must undergo Texas Department of Insurance - Division of Workers Compensation TDI-DWC compliance audit in FY2011
Violation:  Failed to timely pay TIBs; Failed to submit accurate data to TDI-DWC


City of San Antonio of San Antonio
Order Number: DWC-100096
Date of Order:  11/5/2010
Order Final In:   November
Action Taken:  Fined $7,000
Violation:  Failed to accept a communication in the absence of DWC Form-001 as notice of injury and failed to contact employer within seven days of notification; Failed to timely pay a Texas Department of Insurance - Division of Workers Compensation TDI-DWC or Commissioner Order


Commerce and Industry Insurance Company of New York City, NY
Order Number: DWC-100110
Date of Order:  11/16/2010
Order Final In:   November
Action Taken:  Fined $60,000
Violation:  Failed to timely process medical bills; Failed to sufficiently explain reasons for the reduction or denial of payment for health care services; Failed to timely pay TIBs; Failed to timely comply with a Medical Dispute Resolution order; Failed to timely comply with a Contested Case Hearing order


Dallas Area Rapid Transit of Austin
Order Number: DWC-100104
Date of Order:  11/12/2010
Order Final In:   November
Action Taken:  Fined $18,000
Violation:  Failed to timely pay TIBs; Failed to submit accurate data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC; Failed to timely take final action on a request for reconsideration of a medical bill


Durkop, David Allen D.C. of Houston
Order Number: DWC-100102
Date of Order:  11/12/2010
Order Final In:   November
Action Taken:  Voluntary withdrawal as treating, consulting and/or referring doctor until March 1, 2014; Allowed to continue to act as Designated Doctor, RME Doctor and/or Peer Review Doctor
Violation:  Provided treatment that did not comport with Texas Department of Insurance - Division of Workers Compensation TDI-DWC treatment guidelines and/or principles of evidence-based medicine; Failed to promote a timely, appropriate return to work consistent with evidence-based lost time guideline


Elliston, Bruce M.D. of Addsion
Order Number: DWC-100114
Date of Order:  11/18/2010
Order Final In:   November
Action Taken:  Fined $10,000
Violation:  Failed to file DWC Form-69 in a timely manner; Failed to file DWC Form-69 with the carrier via facsimile or electronic submission


Farmers Insurance Exchange of Austin
Order Number: DWC-100105
Date of Order:  11/12/2010
Order Final In:   November
Action Taken:  Fined $3,500
Violation:  Failed to comply with TDI-DWC or Commissioner Order; Failed to pay a Texas Department of Insurance - Division of Workers Compensation TDI-DWC or Commissioner Order


Fidelity & Guaranty Insurance Company of Saint Paul, MN
Order Number: DWC-100097
Date of Order:  11/5/2010
Order Final In:   November
Action Taken:  Fined $50,000
Violation:  Failed to timely pay SIBs; Failed to take final action on request for reconsideration of a medical bill; Failed to timely process medical bills; Failed to pay for preauthorized treatments/services


Khan, Rashid M.D. of Houston
Order Number: DWC-100112
Date of Order:  11/16/2010
Order Final In:   November
Action Taken:  Fined $10,000
Violation:  Failed to file DWC Form-69 in a timely manner; Failed to file DWC Form-69 with the carrier via facsimile or electronic submission


Kruesel, Roy G., M.D. of Fort Worth
Order Number: DWC-100111
Date of Order:  11/16/2010
Order Final In:   November
Action Taken:  Fined $15,000
Violation:  Failed to file DWC Form-69 in a timely manner; Failed to file DWC Form-69 with the carrier via facsimile or electronic submission


McCall, Norman J., M.D. of Fort Worth
Order Number: DWC-100107
Date of Order:  11/16/2010
Order Final In:   November
Action Taken:  Fined $6,500
Violation:  Failed to file DWC Form-69 in a timely manner; Failed to file DWC Form-69 with the carrier via facsimile or electronic submission


Medical Center Emergency Physicians of Houston
Order Number: DWC-100103
Date of Order:  11/12/2010
Order Final In:   November
Action Taken:  Fined $7,000
Violation:  Improperly billed injured employee for workers' compensation medical services provided


Pacific Employers Insurance Company of Philadelphia, PA
Order Number: DWC-100098
Date of Order:  11/5/2010
Order Final In:   November
Action Taken:  Fined $15,000
Violation:  Failed to comply with Texas Department of Insurance - Division of Workers Compensation TDI-DWC or Commissioner Order


Sentry Insurance, A Mutual Company of Stevens Point, WI
Order Number: DWC-100108
Date of Order:  11/16/2010
Order Final In:   November
Action Taken:  Fined $7,200
Violation:  Failed to continue to timely pay benefits; Failed to timely pay SIBs; Failed to take final action on request for reconsideration of a medical bill; Failed to timely send DWC Form-PLN9 to injured employee


Star Insurance Company of Southfield, MO
Order Number: DWC-100109
Date of Order:  11/16/2010
Order Final In:   November
Action Taken:  Fined $10,000
Violation:  Failed to timely pay TIBs; Failed to submit accurate data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC; Failed to pay attorney fees as ordered by TDI-DWC


Stuart, John Robert M.D. of Dallas
Order Number: DWC-100106
Date of Order:  11/16/2010
Order Final In:   November
Action Taken:  Fined $5,500
Violation:  Failed to file DWC Form-69 in a timely manner; Failed to file DWC Form-69 with the carrier via facsimile or electronic submission


Texas Political Subdivisions Joint Self-Insurance Funds of Dallas
Order Number: DWC-100095
Date of Order:  11/5/2010
Order Final In:   November
Action Taken:  Fined $20,000
Violation:  Failed to timely pay TIBs; Failed to submit accurate data to Texas Department of Insurance - Division of Workers Compensation TDI-DWC; Failed to timely pay or deny a request for reimbursement submitted by injured employee


Westfield Insurance Company of Wsetfield Center, OH
Order Number: DWC-100099
Date of Order:  11/5/2010
Order Final In:   November
Action Taken:  Fined $5,000
Violation:  Failed to timely comply with an Interlocutory Order for payment of accrued and unpaid income benefits


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-100115
Date of Order:  11/18/2010
Order Final In:   November
Action Taken:  Fined $45,000
Violation:  Failed to timely submit data to TDI-DWC; Failed to timely initiate TIBs; Failed to timely respond to a TDI-DWC request for information; Failed to submit accurate data to TDI-DWC; Failed to comply with TDI-DWC or Commissioner Order; Failed to pay benefits based on opinion of the Designated Doctor while dispute pending; Failed to timely process medical bills; Failed to make payment for health care services in accordance with Texas Department of Insurance - Division of Workers Compensation TDI-DWC's fee guidelines medical policies; Failed to sufficiently explain reasons for the reduction or denial of payment for health care services


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-100092
Date of Order:  10/22/2010
Order Final In:   October
Action Taken:  Fined $14,000
Violation:  Failed to properly file notice when reduced or denied payment or services; Failed to timely pay or dispute initial temporary income benefits payment within 15 days of notice of injury; Failed to timely process and take final action on a correctly completed request for reconsideration on a medical bill within 21 days


Hood, James F. M.D. of Houston
Order Number: DWC-100090
Date of Order:  10/19/2010
Order Final In:   October
Action Taken:  Fined $10,000; Must attend Division educational conference on roles and responsibilities of health care providers
Violation:  Failed to file the DWC Form-069 in a timely manner; Failed to submit DWC Form-069 to the insurance carrier via facsimile or electronic transmission; Failed to timely respond to a letter of clarification; Refused four Designated Doctor appointments within 90 days


Liberty Insurance Corporation of Boston, MA
Order Number: DWC-100087
Date of Order:  10/8/2010
Order Final In:   October
Action Taken:  Fined $153,000
Violation:  Failed to timely pay for preauthorized medical services; Failed to timely process and take final action on a correctly completed request for reconsideration on a medical bill within 21 days; Failed to sufficiently explain reason for denying or reducing payment on a medical bill; Failed to pay temporary income benefits to injured employee; Failed to timely pay impairment income benefits; Failed to take final action on medical bill no later than 45th day after received completed bill


Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC-100088
Date of Order:  10/8/2010
Order Final In:   October
Action Taken:  Fined $50,000
Violation:  Failed to timely process and take final action on a correctly completed request for reconsideration on a medical bill within 21 days; Failed to sufficiently explain reason for denial or reduction of payment on medical bill; Failed to pay for preauthorized medical services; Failed to take final action on medical bill no later than 45th day after received completed bill; Failed to timely pay temporary income benefits to injured employee


Liberty Mutual Insurance Company of Boston, MA
Order Number: DWC-100085
Date of Order:  10/8/2010
Order Final In:   October
Action Taken:  Fined $17,000
Violation:  Failed to accept communication in absence of DWC Form-001 as notice of injury and failed to contact employer within seven days of notification; Failed to timely pay supplemental income benefits; Failed to timely pay Division order or Commissioner order; Failed to solicit request for safety information or assistance from policyholder


LM Insurance Corporation of Boston, MA
Order Number: DWC-1000086
Date of Order:  10/8/2010
Order Final In:   October
Action Taken:  Fined $30,000
Violation:  Improperly denied payment for preauthorized medical services; Failed to timely process and take final action on a correctly completed request for reconsideration on a medical bill within 21 days; Failed to sufficiently explain denial or reduction of payment on a medical bill; Failed to pay temporary income benefits to an injured employee


Massenburg, Bryan M.D. of Longview
Order Number: DWC-100089
Date of Order:  10/8/2010
Order Final In:   October
Action Taken:  Fined $12,000; Must attend Division educational course on roles and responsibilities of health care providers; 
Violation:  Failed to timely file DWC Form-069 with the insurance carrier (92 instances); Failed to file the DWC Form-069 with carrier via facsimile or electronic transmission (92 instances)


Southern Vanguard Insurance Company of Dallas
Order Number: DWC-100091
Date of Order:  10/19/2010
Order Final In:   October
Action Taken:  Fined $15,000
Violation:  Failed to initiate payment of temporary income benefits or file a notice of refusal; Inaccurately reported to the Division actions taken on a claim; Failed to timely process and take final action on a correctly completed request for reconsideration on a medical bill within 21 days


West Houston Radiology Associates of Houston
Order Number: DWC-100093
Date of Order:  10/22/2010
Order Final In:   October
Action Taken:  Fined $2,500
Violation:  Billed injured employee for medical treatments or services when carrier not relieved of liability for costs of health care and injured employee did not violate Labor Code


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-10-0079
Date of Order:  9/16/2010
Order Final In:   September
Action Taken:  Fined $74,000
Violation:  Failed to pay medical costs related to an emergency or treatments/services that require preauthorization when preauthorized; Failed to timely respond to request for preauthorization


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-10-0080
Date of Order:  9/16/2010
Order Final In:   September
Action Taken:  Fined $147,000
Violation:  Failed to comply with decision or order of the Texas Department of Insurance - Division of Workers Compensation TDI-DWC Commissioner; Failed to pay indemnity benefits; Failed to timely pay medical benefits; Failed to pay medical bills according to TDI-DWC Medical Fee Guidelines


Holleman, James F., Jr. D.O. of Tyler
Order Number: DWC-10-0078
Date of Order:  9/10/2010
Order Final In:   September
Action Taken:  Cease and desist from providing health care services in the workers' compensation system
Violation:  Failed to follow current guidelines for evaluation of expected or average return-to-work timeframes; Failed to provide reasonable and necessary care to injured employee; Failed to maintain efficient utilization of health care


Methodist Hospital of Cincinnati, OH
Order Number: DWC-10-0083
Date of Order:  9/29/2010
Order Final In:   September
Action Taken:  Fined $8,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Najera, Raul Abel M.D. of Dallas
Order Number: DWC-10-0074
Date of Order:  9/3/2010
Order Final In:   September
Action Taken:  Fined $2,000
Violation:  Failed to file DWC Form-69 in a timely manner; Failed to timely file a narrative report; Failed to timelyl respond to a Letter of Clarification


Refaeian, Manouchehr M.D. of Austin
Order Number: DWC-10-0081
Date of Order:  9/29/2010
Order Final In:   September
Action Taken:  Fined $20,000; Suspended from Designated Doctor List for six months beginning December 1, 2010
Violation:  Failed to timely file DWC Form-69 with Texas Department of Insurance - Division of Workers Compensation TDI-DWC (133 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic transmission (136 instances)


Shanti, Ihsan M.D. of Houston
Order Number: DWC-10-0073
Date of Order:  9/3/2010
Order Final In:   September
Action Taken:  Withdrawal from practicing in the Texas workers' compensation system 
Violation:  License to practice medicine revoked, suspended or not renewed by appropriate licensing or certification authority; Sought payment for medical services which were not rendered


Southwestern Bell Telephone, LP of Dallas
Order Number: DWC-10-0072
Date of Order:  9/3/2010
Order Final In:   September
Action Taken:  Fined $3,500
Violation:  Failed to take final action on a medical bill not later than the 45th day after the date complete medical bill received; Violated administrative rules by providing notice disputing future medical benefits


Standard Fire Insurance Company of Hartford, CT
Order Number: DWC-10-0071
Date of Order:  9/3/2010
Order Final In:   September
Action Taken:  Fined $8,000
Violation:  Failed to timely issue initial Temporary Income Benefits (TIBs); Failed to timely report initial TIBs payments; Failed to accurately report First Dates of Disability


Voge, Victoria M. M.D. of Round Rock
Order Number: DWC-10-0082
Date of Order:  9/29/2010
Order Final In:   September
Action Taken:  Fined $5,000; Must maintain current appointment location matrix for six months; Must attend educational conference on roles and responsibilities of health care providers in workers' compensation system
Violation:  Failed to file DWC Form-69 in timely manner; Failed to timely file DWC Form-69 with insurance carrier; Failed to notify Texas Department of Insurance - Division of Workers Compensation TDI-DWC with time and date of rescheduled appointment


Advantage Workers Compensation Insurance Company of Salt Lake City, UT
Order Number: DWC-10-0065
Date of Order:  8/18/2010
Order Final In:   August
Action Taken:  Fined $6,000
Violation:  Failed to comply with order or decision of the Commissioner


Argonaut Southwest Insurance Company of San Antonio
Order Number: DWC-10-0054
Date of Order:  8/3/2010
Order Final In:   August
Action Taken:  Fined $3,000
Violation:  Failed to timely pay or dispute benefits


Atlin, Neil J. D.O. of Dallas
Order Number: DWC-10-0059
Date of Order:  8/6/2010
Order Final In:   August
Action Taken:  Agreed to attend a pain management course and to forward to the Division all documentation that was submitted to the carriers for preauthorization requests for initial implantation of spinal cord stimulators and/or pain pumps after he receives the carriers' approval or denial. The agreement to attend this course is not an admission or evidence of fault with respect to the validity of any claim or defense, or the amount of any claim by any of the parties, concerning the matters in controversy. The purpose of the provision regarding preauthorizations is to generally evaluate and improve the preauthorization process involving spinal cord stimulators and pain pumps.
Violation:  The Division alleged that Dr. Atlin misdiagnosed cases, he failed to document his diagnoses with physical exam findings, he provided improper treatment, and he delivered excessive, unnecessary, unreasonable medical treatment that did not meet professionally recognized standards of care. Dr. Atlin provided a response and submitted documentation, complete medical records, and reports from certified pain management specialists that he believes provides evidence that his diagnosis and treatment of the patients was proper, well documented and met professionally recognized standards.


Fedex Freight of Memphis, TN
Order Number: DWC-10-0060
Date of Order:  8/12/2010
Order Final In:   August
Action Taken:  Fined $14,000
Violation:  Failed to timely pay or dispute benefits; Failed to accurately submit medical bill and payment data to the Division within 30 days after insurance carrier makes payment, denies payment or receives refund of overpayment; failed to timely pay an order for attorneys fees


Insurance Company of the State of Pennsylvania of Harrisburg, PA
Order Number: DWC-10-0067
Date of Order:  8/25/2010
Order Final In:   August
Action Taken:  Fined $175,000
Violation:  Failure to comply with workers' compensation system adminstrative rules and procedures (43 instances)


King County Emergency Medical Services of Guthrie
Order Number: DWC-10-0058
Date of Order:  8/3/2010
Order Final In:   August
Action Taken:  Fined $1,000
Violation:  Submitted bill for payment to injured employee; Pursued private claim against injured employee


New Hampshire Insurance Company of New York, NY
Order Number: DWC-10-0068
Date of Order:  8/25/2010
Order Final In:   August
Action Taken:  Fined $175,000
Violation:  Failure to comply with workers' compensation system adminstrative rules and procedures


Northern Insurance Company of New York of Schaumburg, IL
Order Number: DWC-10-0055
Date of Order:  8/3/2010
Order Final In:   August
Action Taken:  Fined $6,000
Violation:  Failed to timely comply with a medical fee dispute decision and order


Roos, Linda J., M.D. of Houston
Order Number: DWC-10-0066
Date of Order:  8/18/2010
Order Final In:   August
Action Taken:  Cease and desist from providing or rendering health care services in workers' compensation system
Violation:  Engaged in conduct relating to delivery, evaluation, or remuneration of health that Division finds is unreasonable and does not meet standards of health care


Texas Cotton Ginners Trust of Austin
Order Number: DWC-10-0064
Date of Order:  8/18/2010
Order Final In:   August
Action Taken:  Fined $5,500
Violation:  Failed to timely pay or dispute benefits (three instances); Failed to accurately submit claim data to the Division (16 instances)


The Gray Insurance Company of Metairie, LA
Order Number: DWC-10-0063
Date of Order:  8/18/2010
Order Final In:   August
Action Taken:  Fined $25,000
Violation:  Failed to timely pay or dispute benefits; Failed to timely pay or deny payment of medical bills; Failed to timely and/or accurately submit medical bill and claim data to Division electronically; Failed to timely file accident prevention services annual report


Van Hal, Marvin M.D. of Southlake
Order Number: DWC-10-0056
Date of Order:  8/3/2010
Order Final In:   August
Action Taken:  Fined $1,000
Violation:  Filed to timely file the DWC Form-69 with the insurance carrier (25 instances); Failed to file the DWC Form-69 to insurance carrier via facsimile or electronic transmission (26 instances)


Wausau Business Insurance Company of Boston, MA
Order Number: DWC-10-0057
Date of Order:  8/3/2010
Order Final In:   August
Action Taken:  Fined $5,000
Violation:  Failed to timely pay or dispute benefits


Daniels, Michael M.D. of Arlington
Order Number: DWC-10-0046
Date of Order:  7/5/2010
Order Final In:   July
Action Taken:  Fined $2,500; Must complete training
Violation:  Failed to timely file DWC Form-69 with insurance carrier; Failed to file DWC Form-69 with the carrier via facsimile or electronic submission


Driver Pipeline Company, Inc. of Irving
Order Number: DWC-10-0051
Date of Order:  7/22/2010
Order Final In:   July
Action Taken:  Fined $12,000
Violation:  Failed to timely pay benefits ordered by Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Jafarnia, Kourosh Korsh M.D. of Houston
Order Number: DWC-10-0052
Date of Order:  7/22/2010
Order Final In:   July
Action Taken:  Must not reapply for authorization to certify maximum medical improvement and assign impairment ratings for one year
Violation:  Failed to timely file DWC Form-69 with insurance carrier (18 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic submission (23 instances)


American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-10-0035
Date of Order:  6/4/2010
Order Final In:   June
Action Taken:  Fined $30,000
Violation:  Failed to pay for preauthorized medical services; Failed to comply with TDI-DWC or Commissioner Order (four instances); Failed to timely process medical bills; Failed to submit accurate data to Texas Department of Insurance - Division of Workers Compensation  TDI-DWC (10 instances)


Clogston, Curtis M.D. of San Marcos
Order Number: DWC-10-0039
Date of Order:  6/16/2010
Order Final In:   June
Action Taken:  Fined $8,000; Must provide copy of compliance plan; Must complete training
Violation:  Failed to timely file the DWC Form-69 with insurance carrier (62 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic submission (62) instances; Failed to timely file letter of clarification; Refused four or more designated doctor appointments in 90 days


Dolgencorp of Texas, Inc. of Goodlettsville, TN
Order Number: DWC-10-0041
Date of Order:  6/30/2010
Order Final In:   June
Action Taken:  Fined $32,000
Violation:  Failed to notify injured worker of actions taken on claim; Failed to begin to pay benefits as required or timely file notice of denial of compensability; Failed to timely initiate TIBs; Failed to take timely action on medical bill; Failed to accurately submit medical bill and payment data to Texas Department of Insurance - Division of Workers Compensation  TDI-DWC


Federal Insurance Company of Warren, NJ
Order Number: DWC-10-0043
Date of Order:  6/30/2010
Order Final In:   June
Action Taken:  Fined $30,000; Must submit compliance plan
Violation:  Improper denial of payment for preauthorized medical services (two instances); Failed to timely act on medical bills; Failed to timely pay TIBs in accordance with Designated Doctor's report; Failed to timely pay for services deemed necessary in Independent Review Organization decision.


Hartford Casualty Insurance Company of Hartford, CT
Order Number: DWC-10-0044
Date of Order:  6/30/2010
Order Final In:   June
Action Taken:  Fined $42,000
Violation:  Failed to pay for preauthorized medical services; Failed to timely respond to a request for preauthorization; Failed to provide sufficient explanation for denial of payment for medical services; Failed to timely initiate TIBs (30 instances); Failed to submit accurate data to Texas Department of Insurance - Division of Workers Compensation  TDI-DWC (78 instances)


Hartford Insurance Company of the Midwest of Hartford, CT
Order Number: DWC-10-0045
Date of Order:  6/30/2010
Order Final In:   June
Action Taken:  Fined $50,000
Violation:  Failed to notify TDI-DWC and injured employee of actions taken on claim; Filed to timely pay benefits or file notice of denial; Failed to timely initiate payment of TIBs; Failed to timely act on properly completed medical bill; Failed to pay for preauthorized medical services; Failed to accurately submit medical bill and payment data to Texas Department of Insurance - Division of Workers Compensation  TDI-DWC


Netherlands Insurance Company of Boston, MA
Order Number: DWC-10-0037
Date of Order:  6/4/2010
Order Final In:   June
Action Taken:  Fined $6,000
Violation:  Failed to comply with Texas Department of Insurance - Division of Workers Compensation  TDI-DWC ordered advance within seven days of receipt of order


The Travelers Indemnity Company of Connecticut of Hartford, CT
Order Number: DWC-10-0040
Date of Order:  6/24/2010
Order Final In:   June
Action Taken:  Fined $250,000
Violation:  Failed to timely forward Independent Review Organization requests to Texas Department of Insurance - Division of Workers Compensation TDI


Toledo, Luiz M.D. of Fort Worth
Order Number: DWC-10-0038
Date of Order:  6/16/2010
Order Final In:   June
Action Taken:  Fined $5,000; Provide copy of compliance plan; Must complete training
Violation:  Failed to timely file DWC Form-69 with insurance carrier (91 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic submission


Vredenburgh, Jesse W. D.O. of Portland
Order Number: DWC-10-0042
Date of Order:  6/30/2010
Order Final In:   June
Action Taken:  Fined $5,000; Must limit locations for designated doctor examinations for one year; Must complete training
Violation:  Failed to timely reexamine injured employee; Failed to timely file DWC Form-69 with Texas Department of Insurance - Division of Workers Compensation  TDI-DWC (101) instances; Failed to timely file letter of clarification (six instances)


Weeks, Trenton M.D. of Flower Mound
Order Number: DWC-10-0036
Date of Order:  6/4/2010
Order Final In:   June
Action Taken:  Fined $5,000; Suspended from Designated Doctor List for three months
Violation:  Failed to timely file DWC Form-69 with insurance carrier (37 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic submission (41 instances)


Drazner, Bryan M.D. of Dallas
Order Number: DWC-10-0034
Date of Order:  5/10/2010
Order Final In:   May
Action Taken:  Fined $15,000; Suspended from Designated Doctor List for six months
Violation:  Failed to timely file DWC Form-69 with insurance carrier (72 instances); Failed to provide documentation proving filing of DWC Form-69 (40 instances); Failed to timely file letter of clarification


Ninala, Ranil M.D. of Dallas
Order Number: DWC-10-0033
Date of Order:  5/10/2010
Order Final In:   May
Action Taken:  Fined $6,000
Violation:  Failed to timely file DWC Form-69 with insurance carrier (26 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic transmission (14 instances);


Onabajo, Catherine Eno Okpon M.D. of Lewisville
Order Number: DWC-10-0032
Date of Order:  5/10/2010
Order Final In:   May
Action Taken:  Fined $1,000; Suspended from Designated Doctor List for six months; 
Violation:  Failed to timely reschedule Designated Doctor appointment; Failed to timely notify injured employee of rescheduled appointment; Failed to timely file narrative report with insurance carrier; Failed to timely file DWC Form-69 with the Texas Department of Insurance - Division of Workers Compensation TDI-DWC (23 instances); Failed to timely file letter of clarification (seven instances)


Albrand, Otmar M.D. of Austin
Order Number: DWC-10-0028
Date of Order:  4/30/2010
Order Final In:   April
Action Taken:  Fined $10,000; Must implement compliance plans submitted to the TDI-DWC
Violation:  Failed to timely file letter of clarification (two instances); Failed to timely file DWC Form-069 with the Texas Department of Insurance - Division of Workers Compensation  TDI-DWC (four instances); Failed to timely notify injured employee of appointment changes; Failed to timely conduct re-examination pursuant to letter of clarification request


Driggers, Kimberley D.C. of New Braunfels
Order Number: DWC-10-0026
Date of Order:  4/30/2010
Order Final In:   April
Action Taken:  Cease and desist from practicing before the TDI-DWC as health care practitioner for 10 years
Violation:  Failed to timely file required medical records; Failed to timely comply with Texas Department of Insurance - Division of Workers Compensation  TDI-DWC order to produce medical records


Frazier, M. Lewis Jr., M.D. of Plano
Order Number: DWC-10-0027
Date of Order:  4/30/2010
Order Final In:   April
Action Taken:  Fined $5,000; Suspended from Designated Doctor List for six months; Must complete existing designated doctor assignments; Must timely respond to TDI-DWC requests for letters of clarification; Must submit a compliance plan to TDI-DWC.
Violation:  Failed to timely file the DWC Form-069 with the Texas Department of Insurance - Division of Workers Compensation  TDI-DWC (five instances)


Neel, Richard L. M.D. of San Antonio
Order Number: DWC-10-0030
Date of Order:  4/30/2010
Order Final In:   April
Action Taken:  Fined $30,000; Must provide compliance plan to the TDI-DWC
Violation:  Failed to timely file the DWC Form-069 with the Texas Department of Insurance - Division of Workers Compensation  TDI-DWC (94 instances); Failed to file the DWC Form-069 with the insurance carrier via facsimile or electronic transmission (88 instances)


Oakes, Walter H. M.D. of Galveston
Order Number: DWC-10-0029
Date of Order:  4/30/2010
Order Final In:   April
Action Taken:  Fined $6,500; Must maintain proper records/documentation and follow compliance plan
Violation:  Failed to timely file the DWC Form-069 with the insurance carrier (23 instances); Failed to file DWC Form-069 with the carrier via facsimile or electronic transmission (23 instances)


Service Lloyds Insurance Company of Austin
Order Number: DWC-10-0031
Date of Order:  4/30/2010
Order Final In:   April
Action Taken:  Fined $10,000
Violation:  Failed to pay reasonable and necessary medical costs relating to treatments/services which were preauthorized; Failed to sufficiently explain reason for reduction or denial of payment for health services provided to injured employee


Arrowood Indemnity Company of Charlotte, NC
Order Number: DWC-10-0017
Date of Order:  3/9/2010
Order Final In:   March
Action Taken:  Fined $6,000
Violation:  Failed to respond to aTexas Department of Insurance - Division of Workers Compensation  TDI-DWC request for information (three instances)


Garrison, Christopher M.D. of Austin
Order Number: DWC-10-0022
Date of Order:  3/22/2010
Order Final In:   March
Action Taken:  Suspended from Designated Doctor List for 90 days; Must complete scheduled appointments and examinations; Must not modify appointment location matrix for 90 days; Must provide compliance plan to Texas Department of Insurance - Division of Workers Compensation TDI-DWC
Violation:  Failed to timely file letter of clarification; Failed to timely file DWC Form-069 with insurance carrier (10 instances); Failed to file DWC Form-069 with the insurance carrier via facsimile or electronic transmission (three instances)


Lindsey, William H. M.D. of Denton
Order Number: DWC-10-0016
Date of Order:  3/9/2010
Order Final In:   March
Action Taken:  Removed from Designated Doctor List; Prohibited from practicing as designated doctor or certifying doctor
Violation:  Failed to file a letter of clarification in a timely manner (two instances); Failed to timely conduct an examination after a cancelled appointment; Failed to timely file DWC Form-069 with the Texas Department of Insurance - Division of Workers Compensation  TDI-DWC (two instances)


Morse, Jack A. M.D. of Denton
Order Number: DWC-10-0019
Date of Order:  3/22/2010
Order Final In:   March
Action Taken:  Must not reapply for admission to Designated Doctor List for one year
Violation:  Failed to timely file letter of clarification (three instances); Failed to timely file DWC Form-069 with the insurance carrier (10 instances); Failed to timely notify the Texas Department of Insurance - Division of Workers Compensation  TDI-DWC of rescheduled designated doctor appointment; Failed to schedule or perform four designated doctor appointments within 90 days


Parks, Lawrence D.C. of League City
Order Number: DWC-10-0021
Date of Order:  3/22/2010
Order Final In:   March
Action Taken:  Fined $2,500; Must maintain proper records/documentation and follow compliance plan
Violation:  Failed to timely file DWC Form-069 with the insurance carrier (14 instances); Failed to file DWC Form-069 with the insurance carrier via facsimile or electronic transmission (14 instances)


Texas Mutual Insurance Company of Austin
Order Number: DWC-10-0020
Date of Order:  3/22/2010
Order Final In:   March
Action Taken:  Fined $24,000
Violation:  Failed to use a doctor licensed in Texas to review medical necessity of health care services requested by health care provider (six instances)


Varela, Humberto M.D. of Laredo
Order Number: DWC-10-023
Date of Order:  3/23/2010
Order Final In:   March
Action Taken:  Suspended from Designated Doctor List for 18 months; Must complete existing appointments and examinations and respond to TDI-DWC requests for letters of clarification; Must not modify appointment location matrix
Violation:  Failed to timely file the DWC Form-069 with the insurance carrier (44 instances); Failed to file the DWC Form-069 with the insurance carrier via facsimile or electronic transmission (50 instances)


Driggs, Guy Jr. M.D. of Irving
Order Number: DWC-10-0011
Date of Order:  2/26/2010
Order Final In:   February
Action Taken:  Fined $6,000; Suspended from designated doctor list for four months; Must not modify appointment location matrix for four months; After four-month suspension, must limit locations of designated doctor appointments to specific counties for one year
Violation:  Failed to timely and properly file reports of medical evaluations


Jones, Audrey Lee M.D. of Alamo
Order Number: DWC-10-0010
Date of Order:  2/26/2010
Order Final In:   February
Action Taken:  Ordered not to renew designated doctor certification
Violation:  Failed to timely file DWC Form-69 (six instances)


King, Jeff Alan D.C. of Garland
Order Number: DWC-100008
Date of Order:  2/22/2010
Order Final In:   February
Action Taken:  Fined $12,000; Must maintain proper records/documentation and adhere to compliance plan
Violation:  Failed to timely and properly file reports of medical evaluations


Lifland, Paul D. M.D. of Eagle Pass
Order Number: DWC-100005
Date of Order:  2/16/2010
Order Final In:   February
Action Taken:  Fined $1,500; Suspended from designated doctor list for 30 months
Violation:  Failed to file reports of medical evaluations and failed to respond in a timely manner to requests for clarification from Texas Department of Insurance - Division of Workers Compensation TDI-DWC


Lopez, Alejandro M.D. of Alice
Order Number: DWC-10-0004
Date of Order:  2/16/2010
Order Final In:   February
Action Taken:  Agreed to withdraw as a health care provider in the workers’ compensation system and to discontinue providing services or billing for services in the workers’ compensation system
Violation:  Failed to timely and properly file reports of medical evaluations


Steele, John G. M.D. of San Antonio
Order Number: DWC-100009
Date of Order:  2/22/2010
Order Final In:   February
Action Taken:  Fined $2,000; Suspended from designated doctor list for six months; Must provide Texas Department of Insurance - Division of Workers Compensation TDI-DWC with compliance plan; Must not modify appointment location matrix for six months
Violation:  Failed to timely file reports of medical evaluations; Failed to timely reschedule designated doctor examinations


Villarreal, Luis F. M.D. of Laredo
Order Number: DWC-100006
Date of Order:  2/16/2010
Order Final In:   February
Action Taken:  Agreed to not reapply for designated doctor certification for one year
Violation:  Consent order alleged that failed to timely file reports of medical evaluations; Failed to timely respond to requests for letters of clarification; Failed to timely make contact with injured employee to reschedule designated doctor appointments; Failed to timely notify Texas Department of Insurance - Division of Workers Compensation  TDI-DWC of rescheduled designated doctor appointment; Failed to timely reschedule designated doctor appointments


Xeller, Charles F. M.D. of Dallas
Order Number: DWC-100007
Date of Order:  2/22/2010
Order Final In:   February
Action Taken:  Suspended from designated doctor list for one year; Must maintain current appointment location matrix; Must maintain proper records/documentation and adhere to TDI-DWC compliance plan
Violation:  Failed to timely and properly file reports of medical evaluation; Failed to respond in a timely manner to requests for clarification from Texas Department of Insurance - Division of Workers Compensation TDI-DWC; Failed to timely reschedule a designated doctor appointment


2009

Coolbaugh, Robert J., D.C. of Lubbock
Order Number: DWC-09-0066
Date of Order:  12/18/2009
Order Final In:   December
Action Taken:  Must timely respond to document requests related to quarterly review of patient charts; Must pay review fees; Must complete 12 hours continuing education
Violation:  Failed to provide reasonable and necessary health care (seven instances); Failed to timely and appropriately release employees to return to work (two instances)


North American Specialty Insurance Company of Manchester, NH
Order Number: DWC-09-0064
Date of Order:  12/18/2009
Order Final In:   December
Action Taken:  Fined $3,000. Must provide requested information and access to requested records
Violation:  Failed to timely respond to data requests


Oluwole, Dr. Babalola O. of Lewisville
Order Number: DWC-09-0065
Date of Order:  12/18/2009
Order Final In:   December
Action Taken:  Removed from Designated Doctor List; Ordered to cease and desist from practicing before Division as a designated doctor or as an approved/certifying doctor
Violation:  Failed to file letter of clarification in a timely manner (six instances); Failed to timely file DWC Form-69 with insurance carrier (18 instances)


United States Fire Insurance Company of Plano
Order Number: DWC-09-0072
Date of Order:  12/22/2009
Order Final In:   December
Action Taken:  Fined $10,500
Violation:  Failed to pay for preauthorized treatments or services (two instances); Improper retrospective review of preauthorized treatments or services (two instances); Failed to pay initial Temporary Income Benefits in a timely manner (three instances); Submitted inaccurate information on initial payment of Temporary Income Benefits (12 instances)


Gullapalli, Dr. Uma R. of Victoria
Order Number: DWC-09-0061
Date of Order:  11/6/2009
Order Final In:   November
Action Taken:  Removed from Designated Doctor List; Ordered to cease and desist from practicing before Division as a designated doctor or as an approved/certifying doctor
Violation:  Failed to file a response to letter of clarification in a timely manner (four instances); Failed to file DWC Form-69 in a timely manner (126 instances); Failed to file DWC Form-69 with carrier by facsimile or electronic transmission (122 instances); Failed to meet 95 percent compliance standard for timely filing DWC Form-69 and for properly filing DWC Form-69 with the carrier


Dilger, Dr. J. Thomas of Spring
Order Number: DWC-09-0057
Date of Order:  9/17/2009
Order Final In:   September
Action Taken:  Fined $3,000. Must follow compliance plan, must pay for additional review of randomly selected impairment rating examinations
Violation:  Engaged in excessive billing by unbundling procedures and examinations (eight instances); Performed excessive and unnecessary exams and billed for noncompensable injuries, conditions or body parts


American Home Assurance Company of Chicago, IL
Order Number: DWC-09-0053
Date of Order:  8/28/2009
Order Final In:   August
Action Taken:  $48,000 Administrative Penalty
Violation:  Failure to timely comply with a decision or order of the commission (two instances); Failure to take final action on a complete medical bill (four instances); Failure to pay for preauthorized medical services (three instances); Failure to timely respond to request for reconsideration


American Home Assurance Company of Chicago, IL
Order Number: DWC-09-0054
Date of Order:  8/28/2009
Order Final In:   August
Action Taken:  $51,500 Administrative Penalty
Violation:  Failure to timely comply with a Division decision or order (two instances); Failure to pay a complete medical bill within 45 days of receipt (two instances); Failure to pay for medical services that had been preauthorized (four instances)


American Home Assurance Company of Chicago, IL
Order Number: DWC-09-0055
Date of Order:  8/28/2009
Order Final In:   August
Action Taken:  $48,000 Administrative Penalty
Violation:  Failure to timely comply with a Division decision or order; Failure to take final action on a medical bill within 45 days of receipt (four instances); Failure to pay for medical services that were preauthorized (three instances)


American Home Assurance Company of Chicago, IL
Order Number: DWC-09-0056
Date of Order:  8/28/2009
Order Final In:   August
Action Taken:  $52,500 Administrative Penalty
Violation:  Failure to timely comply with a decision or order of the commission (two instances); Failure to timely comply with a complete medical bill within 45 days of receipt (six instances); Failure to pay for medical services that had been preauthorized (two instances); Failure to respond to a request for reconsideration within 21 days of receipt


Tarrant County Hospital District of Fort Worth
Order Number: DWC-09-0051
Date of Order:  8/25/2009
Order Final In:   August
Action Taken:  $3,500 Administrative Penalty
Violation:  Failure to timely respond to a request for data (four instances)


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0043
Date of Order:  8/25/2009
Order Final In:   August
Action Taken:  $42,750 Administrative Penalty
Violation:  Improper denial of payment for medical services that were preauthorized (six instances).


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0044
Date of Order:  8/25/2009
Order Final In:   August
Action Taken:  $55,500 Administrative Penalty
Violation:  Improper denial of payment for medical services that were preauthorized (10 instances).


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0045
Date of Order:  8/25/2009
Order Final In:   August
Action Taken:  $59,500 Administrative Penalty
Violation:  Improper denial of payment for medical services that were preauthorized (eight instances).


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0046
Date of Order:  8/25/2009
Order Final In:   August
Action Taken:  $32,500 Administrative Penalty
Violation:  Failure to timely pay a Division or Commissioner oder (five instances).


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0047
Date of Order:  8/25/2009
Order Final In:   August
Action Taken:  $30,000 Administrative Penalty
Violation:  Failure to timely pay a Division or Commissioner order (five instances)


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0048
Date of Order:  8/25/2009
Order Final In:   August
Action Taken:  $19,750 Administrative Penalty
Violation:  Failure to timely pay a Division or Commissioner order (two instances).


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0049
Date of Order:  8/25/2009
Order Final In:   August
Action Taken:  $23,800 Administrative Penalty
Violation:  Failure to timely pay Division or Commissioner order (three instances); failure to timely pay Temporary Income Benefits (TIBs) (three instances)


Zurich American Insurance Company of Schaumberg, IL
Order Number: DWC-09-0050
Date of Order:  8/25/2009
Order Final In:   August
Action Taken:  $36,000 Administrative Penalty
Violation:  Failure to take action on medical bills within 45 days of receipt (10 instances); Failure to timely respond to a request for preauthorization; Failure to timely respond to a Request for Reconsideration; Failure to sufficiently explain reason for denying or reducing payment on a medical bill (eight instances)


City of Plano of Plano
Order Number: DWC-09-0030
Date of Order:  5/8/2009
Order Final In:   May
Action Taken:  $2,500 Administrative Penalty
Violation:  Failure to respond to a TDI-DWC data request in a timely manner.


Employers Mutual Casualty Company of Des Moines, IA
Order Number: DWC-09-0026
Date of Order:  5/1/2009
Order Final In:   May
Action Taken:  $12,500 Administrative Penalty
Violation:  Failure to pay the reasonable and necessary medical costs of treatments/services requiring preauthorization which were approved prior to providing the health care (three instances); inappropriate retrospective review of the medical necessity of preauthorized treatment or services (three instances).


Franz, Jerry Dr. of Irving, TX
Order Number: DWC-09-0025
Date of Order:  5/1/2009
Order Final In:   May
Action Taken:  $3,500 Administrative Penalty
Violation:  Failure to file the Report of Medical Evaluation in a timely manner (11 instances); failure to respond to letters of clarification in a timely manner (three instances); failure to timely re-examine claimants after the letter of clarification request.


Liberty Insurance Corporation of Boston, MA
Order Number: DWC-09-0027
Date of Order:  5/1/2009
Order Final In:   May
Action Taken:  $3,750 Administrative Penalty
Violation:  Failure to use a doctor licensed in the State of Texas to conduct a peer review requested by the health care provider for medical necessity of health care services provided.


Old Republic Insurance Company of Greensburg, PA
Order Number: DWC-09-0028
Date of Order:  5/1/2009
Order Final In:   May
Action Taken:  $7,500 Administrative Penalty
Violation:  Failure to use a doctor licensed in the State of Texas to conduct a peer review requested by the health care provider for medical necessity of health care services provided (two instances).


Service Lloyds Insurance Company of Austin, TX
Order Number: DWC-09-0029
Date of Order:  5/1/2009
Order Final In:   May
Action Taken:  $3,750 Administrative Penalty
Violation:  Failure to use a doctor licensed in the State of Texas to conduct a peer review requested by the health care provider for medical necessity of health care services provided.


Metiscan Corpus Christi of Dallas
Order Number: DWC-09-0022
Date of Order:  4/13/2009
Order Final In:   April
Action Taken:  $1,000 Administrative Penalty and Agreed Cease & Desist Order
Violation:  Misuse of the Texas Department of Insurance/Division of Worker’s Compensation name and/or symbol in 19 documents.


Panzarella, Robert Dr. of Humble
Order Number: DWC-09-0024
Date of Order:  4/16/2009
Order Final In:   April
Action Taken:  $12,500 Administrative Penalty
Violation:  Failure to file the Report of Medical Evaluation in a timely manner (97 instances); failure to file the Report of Medical Evaluation with the insurance carrier by facsimile or electronic transmission (11 instances); failure to respond to letters of clarification in a timely manner (six instances); failure to notify TDI-DWC of rescheduled designated doctor examination (four instances); failure to meet compliance standard of 95 percent.


Zurich American Insurance Company of Schaumberg, IL
Order Number: DWC-09-0021
Date of Order:  4/13/2009
Order Final In:   April
Action Taken:  $1,600 Administrative Penalty
Violation:  Failure to initiate Temporary Income Benefits in a timely manner (three instances).


Gill, Darshan Dr. of McAllen
Order Number: DWC-09-0020
Date of Order:  3/20/2009
Order Final In:   March
Action Taken:  $2,000 Administrative Penalty
Violation:  Failure to respond to letters of clarification in a timely manner (two instances).


Otto, Laurie Dr. of Plano
Order Number: DWC-09-0018
Date of Order:  3/19/2009
Order Final In:   March
Action Taken:  $3,750 Administrative Penalty
Violation:  Failure to file the Report of Medical Evaluation in a timely manner (10 instances); failure to meet the compliance standard of 95 percent.


Texas Municipal League Intergovernmental Risk Pool of Austin
Order Number: DWC-09-0019
Date of Order:  3/19/2009
Order Final In:   March
Action Taken:  $5,000 Administrative Penalty
Violation:  Failure to pay the reasonable and necessary medical costs of treatments/services requiring preauthorization which were approved prior to providing the health care (four instances); inappropriate retrospective review of the medical necessity of preauthorized treatment or services (four instances).


Continental Casualty Company of Chicago, IL
Order Number: DWC-09-0015
Date of Order:  2/27/2009
Order Final In:   February
Action Taken:  $55,000 Administrative Penalty
Violation:  Inappropriate payment or denial of payment of 144 medical bills out of 517 bills reviewed; failure to meet compliance standard for data submission accuracy, timely reporting of medical bill data, or timely processing of medical bills.accuracy, timely reporting medical bill data, or timely processing medical bills.


Dr. Fortenberry, Dewitt C. of Texarkana
Order Number: DWC-09-0012
Date of Order:  2/25/2009
Order Final In:   February
Action Taken:  $1,500 Administrative Penalty
Violation:  Failure to file Report of Medical Evaluation in a timely manner.


National Fire Insurance Company of Chicago, IL
Order Number: DWC-09-0016
Date of Order:  2/27/2009
Order Final In:   February
Action Taken:  $12,000 Administrative Penalty
Violation:  Inappropriate payment or denial or payment of 41 medical bills out of 205 bills reviewed; failure to meet compliance standard for appropriate denial or reduction of a medical bill.


St. Luke's Episcopal Health System of Houston 
Order Number: DWC-09-0011
Date of Order:  2/25/2009
Order Final In:   February
Action Taken:  $1,000 Administrative Penalty
Violation:  Improperly pursuing a private claim against a workers’ compensation claimant when the injury had not been finally adjudicated and the claimant had not been in violation of their selection of a doctor.


Transcontinental Insurance Company of Chicago, IL
Order Number: DWC-09-0014
Date of Order:  2/27/2009
Order Final In:   February
Action Taken:  $18,000 Administrative Penalty
Violation:  Inappropriate payment or denial of payment of 90 medical bills out of 318 medical bills reviewed; failure to meet the compliance standard for appropriate denial or reduction of a medical bill.


Transportation Insurance Company of Chicago, IL
Order Number: DWC-09-0013
Date of Order:  2/27/2009
Order Final In:   February
Action Taken:  $65,000 Administrative Penalty
Violation:  Inappropriate payment or denial of payment of 154 medical bills out of 422 medical bills reviewed; failure to meet the compliance standard for appropriate denial or reduction of a medical bill.


ACIG Insurance Company of Dallas
Order Number: DWC-09-0010
Date of Order:  1/30/2009
Order Final In:   January
Action Taken:  $2,000 Administrative Penalty
Violation:  Failure to take final action on a medical bill no later than the 45th day following receipt.


American Casualty Company of Reading Pennsylvania of Chicago, IL
Order Number: DWC-09-0001
Date of Order:  1/7/2009
Order Final In:   January
Action Taken:  $4,000 Administrative Penalty
Violation:  Failure to use a doctor licensed in the State of Texas to review health care services requested by a health care provider for medical necessity.


American Home Assurance Company of New York City, NY
Order Number: DWC-09-0005
Date of Order:  1/8/2009
Order Final In:   January
Action Taken:  $22,500 Administrative Penalty
Violation:  Failure to use a doctor licensed in the State of Texas to review health care services requested by a health care provider for medical necessity (six instances).


Fidelity and Guaranty Insurance Company of Saint Paul, MN
Order Number: DWC-09-0007
Date of Order:  1/8/2009
Order Final In:   January
Action Taken:  $9,000 Administrative Penalty
Violation:  Late payment for preauthorized services (five instances); improper denial of partial payment for preauthorized services.


Murphy, Charles, M.D. of Plano, TX
Order Number: DWC-09-0003
Date of Order:  1/8/2009
Order Final In:   January
Action Taken:  $45,000 Administrative Penalty
Violation:   Failure to file the Report of Medical Evaluation in a timely manner (106 instances); failure to file the Report of Medical Evaluation before the seven-day deadline expired (106 instances); and failure to meet the compliance standard of 95 percent. 
view order 


New Hampshire Insurance Company of Harrisburg, PA
Order Number: DWC-09-0006
Date of Order:  1/8/2009
Order Final In:   January
Action Taken:  $7,500 Administrative Penalty
Violation:  Failure to use a doctor licensed in the State of Texas to review health care services requested by a health care provider for medical necessity (two instances).


Roberson, Eric, M.D. of Webster, TX
Order Number: DWC-09-0009
Date of Order:  1/30/2009
Order Final In:   January
Action Taken:  $12,300 Administrative Penalty
Violation:  Failure to file the Report of Medical Evaluation in a timely manner (105 instances); failure to file the Report of Medical Evaluation with the insurance carrier by facsimile or electronic transmission (105 instances); failure to file the Report of Medical Evaluation before the seven-day deadline (105 instances); and failure to meet the compliance standard of 95 percent. 
view order


The Insurance Company of the State of Pennsylvania of Harrisburg, PA
Order Number: DWC-09-0004
Date of Order:  1/8/2009
Order Final In:   January
Action Taken:  $7,500 Administrative Penalty
Violation:  Failure to use a doctor licensed in the State of Texas to review health care services requested by a health care provider for medical necessity (two instances).


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0002
Date of Order:  1/7/2009
Order Final In:   January
Action Taken:  $15,000 Administrative Penalty
Violation:  Failure to use a doctor licensed in the State of Texas to review health care services requested by a health care provider for medical necessity (four instances).



2008

Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-08-0094
Date of Order:  12/19/2008
Order Final In:   December
Action Taken:  $37,500 Administrative Penalty
Violation:  Failure to use a doctor licensed in the State of Texas to review health care services requested by a health care provider for medical necessity (10 instances).


Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-08-0095
Date of Order:  12/19/2008
Order Final In:   December
Action Taken:  $7,500 Administrative Penalty
Violation:  Failure to use a doctor licensed in the State of Texas to review health care services requested by a health care provider for medical necessity (two instances).


Employers General Insurance Company of Rock Island, IL
Order Number: DWC-08-0091
Date of Order:  10/16/2008
Order Final In:   October
Action Taken:  $30,000 Administrative Penalty
Violation:  Inappropriate denials of payment for preauthorized services (81 instances); and inappropriate use of denial code to deny payment for services not requiring preauthorization (35 instances), as found during a medical billing and preauthorization processing audit.


Houston Independent School District of Houston, TX
Order Number: DWC-08-0090
Date of Order:  10/16/2008
Order Final In:   October
Action Taken:  $4,000 Administrative Penalty
Violation:  Improper denial of preauthorized services (four instances).


Lowes Home Centers, Inc. of Mooresville, NC
Order Number: DWC-08-0087
Date of Order:  10/16/2008
Order Final In:   October
Action Taken:  $1,500 Administrative Penalty
Violation:  Failure to take final action on a medical bill within 45 days of receipt.


OneBeacon Insurance Company of Boston, MA
Order Number: DWC-08-0086
Date of Order:  10/16/2008
Order Final In:   October
Action Taken:  $18,000 Administrative Penalty
Violation:  Inappropriate denials of payment for preauthorized services (56 instances); and inappropriate use of denial code to deny payment for services not requiring preauthorization (15 instances), as found during a medical billing and preauthorization processing audit.


Sompo Japan Insurance Company of America of New York, NY
Order Number: DWC-08-0088
Date of Order:  10/16/2008
Order Final In:   October
Action Taken:  $15,000 Administrative Penalty
Violation:  Failure to provide an on-site safety visit or other appropriate accident prevention services on a periodic basis and at least every 12 months to policyholders with a premium of $25,000 or more.


Universal Underwriters of Texas Insurance Company of Overland Park, KS
Order Number: DWC-08-0089
Date of Order:  10/16/2008
Order Final In:   October
Action Taken:  $2,200 Administrative Penalty
Violation:  Failure to comply with an order or decision of the workers’ compensation commissioner.


Ace American Insurance Company, Ace Fire Underwriters Insurance Company, Ace Indemnity Insurance Company, Ace Property & Casualty Insurance Company, Bankers Standard Fire and Marine Company, Bankers Standard Insurance Company, Century Insurance Company, Indemnity Insurance Company of North America, Insurance Company of North America, Pacific Employers Insurance Company of Philadelphia, PA
Order Number: DWC-08-0081
Date of Order:  9/4/2008
Order Final In:   September
Action Taken:  $50,000 Administrative Penalty
Violation:  Failure to timely provide information requested by TDI-DWC.


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-08-0074
Date of Order:  8/20/2008
Order Final In:   August
Action Taken:  $17,500 Administrative Penalty
Violation:  Failure to timely pay an Independent Review Organization (IRO) fee; improper denial of a preauthorized medical service; improper denial of a medical bill.


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-08-0075
Date of Order:  8/20/2008
Order Final In:   August
Action Taken:  $14,875 Administrative Penalty
Violation:  Failure to timely initiate temporary income benefits (TIBs) payments.


American Contractors Insurance Group of Dallas, TX
Order Number: DWC-08-0069
Date of Order:  8/20/2008
Order Final In:   August
Action Taken:  $5,000 Administrative Penalty
Violation:  Failure to pay, reduce, deny or determine to audit the health care provider’s claim in a timely manner; failure to comply with an order or decision of the commissioner (two instances).


Howard T. Douglas, M.D. of Irving, TX
Order Number: DWC-08-0080
Date of Order:  8/29/2008
Order Final In:   August
Action Taken:  $10,000 Administrative Penalty
Violation:  Failure to respond to a request for letter of clarification within five days of receipt; failure to timely file a Report of Medical Evaluation with TDI-DWC, the injured employee, the injured employee's representative, and the insurance carrier (three instances).


Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-08-0073
Date of Order:  8/20/2008
Order Final In:   August
Action Taken:  $18,000 Administrative Penalty
Violation:  Failure to reimburse health care provider according to the least of maximum allowable reimbursement (MAR) or the health care provider’s usual and customary charge; failure to pay for medical services that were preauthorized; failure to take final action on a medical bill within 45 days of receipt.


Irving Independent School District of Irving, TX
Order Number: DWC-08-0071
Date of Order:  8/20/2008
Order Final In:   August
Action Taken:  $5,000 Administrative Penalty
Violation:  Failure to timely take action on a medical bill; failure to timely submit information; failure to meet the 95 percent compliance standard.


Old Republic Insurance Company of Greensburg, PA
Order Number: DWC-08-0072
Date of Order:  8/20/2008
Order Final In:   August
Action Taken:  $18,000 Administrative Penalty
Violation:  Failure to timely comply with an order on decision of the workers’ compensation commissioner; failure to timely pay an IRO fee; failure to take final action on a medical bill within 45 days of receipt (two instances).


Pacific Employer's Insurance Company of Philadelphia, PA
Order Number: DWC-08-0076
Date of Order:  8/20/2008
Order Final In:   August
Action Taken:  $1,500 Administrative Penalty
Violation:  Improper denial of a medical bill.


Virginia Surety Company, Inc. of Chicago, IL
Order Number: DWC-08-0070
Date of Order:  8/20/2008
Order Final In:   August
Action Taken:  $7,000 Administrative Penalty
Violation:  Failure to comply with an order or decision of the workers’ compensation commissioner.


American Casualty Company of Reading, Pennsylvania of Chicago, IL
Order Number: DWC-08-0056
Date of Order:  6/10/2008
Order Final In:   June
Action Taken:  $2,950 Administrative Penalty
Violation:  Late payment of temporary income benefits (TIBs).


American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-08-0050
Date of Order:  6/6/2008
Order Final In:   June
Action Taken:  $3,000 Administrative Penalty
Violation:  Failure to take final action on a medical bill within 45 days of receipt (two instances).


Employers Mutual Casualty Company of Des Moines, IA
Order Number: DWC-08-0055
Date of Order:  6/10/2008
Order Final In:   June
Action Taken:  $20,000 Administrative Penalty
Violation:  Improper denial of preauthorized medical services.


Fino, Sameer A. Dr. of Mesquite, TX
Order Number: DWC-08-0054
Date of Order:  6/10/2008
Order Final In:   June
Action Taken:  $1,250 Adminsitrative Penalty
Violation:  Failure to assign a specific date at which maximum medical improvement (MMI) was reached; failure to state an MMI on a Report of Medical Evaluation or to sign the form; failure to comply with a rule of the workers’ compensation commissioner; failure to timely file a Report of Medical Evaluation.


Hartford Casualty Insurance Company, Hartford Insurance Company of the Midwest, Twin City Fire Insurance Company of Hartford, CT
Order Number: DWC-08-0052
Date of Order:  6/6/2008
Order Final In:   June
Action Taken:  $21,000 Administrative Penalty
Violation:  Failure to pay income benefits weekly as and when they accrue without order from the workers’ compensation commissioner; failure to pay supplemental income benefits (SIBs) in a timely manner; failure to continue to pay benefits promptly; failure to pay interest on any accrued but unpaid income benefits; failure to pay SIBS in the correct amount; failure to enclose a copy of the Application for Supplemental Income Benefits with the SIBs payment; and failure to meet the 95 percent compliance standard for timeliness of payment of SIBs, payment of SIBs at the proper rate, correct payment of interest when owed, and timeliness of sending Application for Supplemental Income Benefits.


Hartford Casualty Insurance Company, Hartford Insurance Company of the Midwest, Twin City Fire Insurance Company of Hartford, CT
Order Number: DWC-08-0053
Date of Order:  6/6/2008
Order Final In:   June
Action Taken:  $20,000 Administrative Penalty
Violation:  Failure to make an appropriate payment of charges for medical services; failure to pay for services that were preauthorized; failure to include a correct exception code; failure to contact the requestor or employee within three working days of receipt of a request for preauthorization; and failure to meet the 95 percent compliance standard for timeliness of payments of SIBs, payment of SIBs at the proper rate, correct payment of interest when owed, and timeliness of sending the Application for Supplemental Income Benefits.


American Home Assurance Company, The Insurance Company of the State of Pennsylvania, AIU Insurance Company of New York, NY
Order Number: DWC-08-0047
Date of Order:  5/27/2008
Order Final In:   May
Action Taken:  $49,765.50 Administrative Penalty
Violation:  Violations in two audits consisted of failure to meet the Compliance Standard for timeliness of payments of SIBs, payment of SIBs at the proper rate, correct payment interest when owed and timeliness of sending the TWCC-52.


Amerisure Mutual Insurance Company of Farmington Hills, MI
Order Number: DWC-08-0048
Date of Order:  5/27/2008
Order Final In:   May
Action Taken:  $2,402 Administrative Penalty
Violation:  One violation of failing to give sufficient explanation for a reduction of a medical bill.


Assurance Company of America of Schaumburg, IL
Order Number: DWC-08-0038
Date of Order:  4/15/2008
Order Final In:   April
Action Taken:  $25,000 Administrative Penalty
Violation:  Three violations of a failure to comply with a Division order to pay a HCP unpaid medical fees.


Onebeacon America Insurance Company of Boston, MA
Order Number: DWC-08-0039
Date of Order:  4/15/2008
Order Final In:   April
Action Taken:  $4,000 Administrative Penalty
Violation:  One violation of untimely payment of temporary income benefits.


American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-08-0034
Date of Order:  3/31/2008
Order Final In:   March
Action Taken:  $20,000 Administrative Penalty
Violation:  Failure to comply with an order or decision of the commissioner by failing to issue interest due. Failure to timely pay, reduce, deny or determine to audit a HCP's bill, three instances of failure to timely process and take final action on a properly completed request for reconsideration of a medical bill the carrier previously acted on within 21 days of receipt, two instances for failure to timely pay reduce or deny a medical bill. One instance of failure to pay for medical services which were preauthorized.


Deep East Texas Self Insurance Fund of Jasper, TX
Order Number: DWC-08-0028
Date of Order:  3/20/2008
Order Final In:   March
Action Taken:  $2,000 Administrative Penalty
Violation:  Failure to timely refund an IRO fee upon receipt of an order from the Division regardless of whether an appeal had been filed.


Dolgencorp of Texas Inc. of Goodlettsville, TN
Order Number: DWC-08-0031
Date of Order:  3/31/2008
Order Final In:   March
Action Taken:  $9,000 Administrative Penalty
Violation:  Failure to give sufficient explanation for a reduction or denial of a medical bill, failure to timely take final action on a medical bill after the carrier received the complete medical bill, failure to take final action on a properly completed request for reconsideration of a medical bill within 21 days of receipt.


Fort Worth ISD of Fort Worth, TX
Order Number: DWC-08-0024
Date of Order:  3/19/2008
Order Final In:   March
Action Taken:  $7,800 Administrative Penalty
Violation:  Failure to timely refund an IRO fee upon receipt of an order from the commission regardless of whether an appeal had been or would be filed.


Gullapalli, Uma R., M.D. of Victoria, TX
Order Number: DWC-08-0025
Date of Order:  3/19/2008
Order Final In:   March
Action Taken:  $4,000 Administrative Penalty
Violation:  Untimely or inappropriately filing of TWCC-69's in numerous cases discovered in an audit.


Lumbermen's Underwriting Alliance of Boca Raton, FL
Order Number: DWC-08-0033
Date of Order:  3/31/2008
Order Final In:   March
Action Taken:  $4,000 Administrative Penalty
Violation:  One violation for failure to timely pay, reduce, deny or determine to audit a HCP's claim, and one violation for denying a medical bill for an inappropriate reason.


Universal Underwriters of Texas Insurance Company of Overland Park, KS
Order Number: DWC-08-0032
Date of Order:  3/31/2008
Order Final In:   March
Action Taken:  $12,000 Administrative Penalty
Violation:  Failure to comply with a decision of a hearing officer during the pendency of an appeal to the appeals panel.


Brownsville Independent School District of Brownsville, TX
Order Number: DWC-08-0021
Date of Order:  2/29/2008
Order Final In:   February
Action Taken:  $5,000 Administrative Penalty
Violation:  In 2 instances failure to timely process a medical bill. In one instance, failure to take final action on a correctly completed request for reconsideration of a medical bill.


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-08-0011
Date of Order:  1/24/2008
Order Final In:   January
Action Taken:  $21,000 Administrative Penalty
Violation:  Failure to timely pay temporary income benefits, in 12 instances failure to timely take action on a properly completed medical bill, and in one instance failed to the take final action on a correctly completed request for reconsideration and failed to pay for the reasonable and necessary medical costs after carrier gave preauthorization, and one inappropriate denial of a medical bill.


Ace Fire Underwriter's Insurance Company of Philadelphia, PA
Order Number: DWC-08-0013
Date of Order:  1/24/2008
Order Final In:   January
Action Taken:  $8,000 Administrative Penalty
Violation:  Failure to take timely action in response to a medical bill on three occasions. One instance of failure to properly deny a medical bill.


American Insurance Company of Novato, CA
Order Number: DWC-08-0006
Date of Order:  1/14/2008
Order Final In:   January
Action Taken:  $3,000 Administrative Penalty
Violation:  Failure to timely comply with a Medical Dispute Resolution Order.


American Zurich Insurance Company of Schaumberg, IL
Order Number: DWC-08-0003
Date of Order:  1/14/2008
Order Final In:   January
Action Taken:  $5,700 Administrative Penalty
Violation:  Failure to timely respond to a request for reconsideration and failure to timely comply with an order to pay attorney fees.


City of Dallas of Dallas, TX
Order Number: DWC-08-0002
Date of Order:  1/9/2008
Order Final In:   January
Action Taken:  $50,000 Adminstrative Penalty
Violation:  Numerous violations were found in a medical bill processing audit for failure to timely process and take final action on medical bills; failure to timely and accurately submit information electronically in the form and manner prescribed by the Division, and the company failed to meet the 95% compliance standard in some categories.


Indemnity Insurance Company of North America of Philadelphia, PA 
Order Number: DWC-08-0014
Date of Order:  1/31/2008
Order Final In:   January
Action Taken:  $8,000 Administrative Penalty
Violation:  Failure to timely take action on a properly completed medical bill in 2 instances, one instance of failure to take final action on a correctly completed request for reconsideration, and one instance of late payment on a medical dispute resolution order.


Pacific Employer's Insurance Company of Philadelphia, PA
Order Number: DWC-08-0012
Date of Order:  1/24/2008
Order Final In:   January
Action Taken:  $18,000 Administrative Penalty
Violation:  Failure to pay an advance payment of income benefits ordered by the Division, and on instance of failure to timely take action on a properly completed medical bill.


Universal Underwriter's Insurance Company of Schaumberg, IL
Order Number: DWC-08-0004
Date of Order:  1/14/2008
Order Final In:   January
Action Taken:  $1,500 Administrative Penalty
Violation:  Failure to timely pay or deny a medical bill.


Zurich American Insurance Company of Schaumberg, IL
Order Number: DWC-08-0005
Date of Order:  1/14/2008
Order Final In:   January
Action Taken:  $12,800 Administrative Penalty
Violation:  Failure to timely comply with a Medical Dispute Resolution Order and two instances of failure to timely respond to a request for reconsideration.

2007

Bangale, Anil T., MD of Fort Worth, TX
Order Number: DWC-07-0142
Date of Order:  12/7/2007
Order Final In:   December
Action Taken:  $3,000 Administrative Penalty
Violation:  Failure to timely file a Report of Medical Evaluation with the carrier or carrier's agent.


American Home Assurance Company of New York, New York
Order Number: DWC-07-0121
Date of Order:  11/2/2007
Order Final In:   November
Action Taken:  $3,000 Administrative Penalty
Violation:  Failure to include the correct exception code or provide sufficient explanation at the time the carrier made payment or denied payment on a medical bill.


Great American Alliance Insurance Company of Princeton, NJ
Order Number: DWC-07-0132
Date of Order:  11/30/2007
Order Final In:   November
Action Taken:  $8,000 Administrative Penalty
Violation:  Failed to pay reasonable and necessary medical costs for medical services which were preauthorized by the insurance carrier.


Hyatt Corporation of Chicago, IL
Order Number: DWC-07-0131
Date of Order:  11/30/2007
Order Final In:   November
Action Taken:  $2,000 Administrative Penalty
Violation:  Failure to include the correct exception code or provide sufficient explanation at the time the carrier made payment or denied payment on a medical bill.


Indiana Lumbermens Mutual Insurance Company of Indianapolis, IN
Order Number: DWC-07-0135
Date of Order:  11/30/2007
Order Final In:   November
Action Taken:  $5,000 Administrative Penalty
Violation:  Failed to timely take action on a health care provider's claim and a medical bill.


Insurance Company of the State of Pennsylvania of Harrisburg, PA
Order Number: DWC-07-0123
Date of Order:  11/2/2007
Order Final In:   November
Action Taken:  $6,000 Administrative Penalty
Violation:  In two instances the Company failed to timely take action on a HCP's claim and a medical bill.


Liberty Insuance Corporation of Boston, MA
Order Number: DWC-07-0137
Date of Order:  11/30/2007
Order Final In:   November
Action Taken:  $2,800 Administrative Penalty
Violation:  Failed to give sufficient explanation for a reduction or denial of medical bill.


Liberty Insurance Corporation of Boston, MA
Order Number: DWC-07-0133
Date of Order:  11/30/2007
Order Final In:   November
Action Taken:  $2,000 Administratie Penalty
Violation:  Failure to include the correct exception code or provide sufficient explanation at the time the carrier made payment or denied payment on a medical bill.


Liberty Insurance Corporation of Boston, MA
Order Number: DWC-07-0138
Date of Order:  11/30/2007
Order Final In:   November
Action Taken:  $5,000 Administrative Penalty
Violation:  Failed to give sufficient explanation for a reduction or denial of medical bill.


Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC-07-0136
Date of Order:  11/30/2007
Order Final In:   November
Action Taken:  $2,000 Administrative Penalty
Violation:  Failure to timely take action on a correctly completed request for reconsideration of a medical bill.


Longview Regional Medical Center of Longview, TX
Order Number: DWC-07-0122
Date of Order:  11/2/2007
Order Final In:   November
Action Taken:  $5,000 Administrative Penalty
Violation:  Violated Texas Labor Code § 413.042 by pursuing a private claim against a workers' compensation claimant.


McConnell, John C. M.D. of Greenville
Order Number: DWC-07-0128
Date of Order:  11/26/2007
Order Final In:   November
Action Taken:  $2,000 Administrative Penalty
Violation:  Untimely or inappropriately filed Work Status Reports with the insurance carrier which were discovered in a Division audit.


Westport Insurance Corporation of Overland Park, KS
Order Number: DWC-07-0134
Date of Order:  11/30/2007
Order Final In:   November
Action Taken:  $8,000 Administrative Penalty
Violation:  In 2 instances failed to conduct on-site accident prevention visits, or other appropriate services, at least every 12 months to each policyholder.


Douglas, Howard M.D. of Denton, TX
Order Number: DWC-07-0111
Date of Order:  10/9/2007
Order Final In:   October
Action Taken:  $2,000 Administrative Penalty
Violation:  On two instances failed to timely file the report of medical examination.


Lumbermen's Underwriting Alliance of Boca Raton, FL
Order Number: DWC-07-0018
Date of Order:  10/30/2007
Order Final In:   October
Action Taken:  $25,000 Administrative Penalty
Violation:  On two instances failed to timely comply with a Medical Dispute Resolution. On one instance failed to timely respond to a Commissioner's Order to refund an independent review organization fee.


American Alternative Insurance Corporation of Princeton, NJ
Order Number: DWC-07-0104
Date of Order:  9/28/2007
Order Final In:   September
Action Taken:  $6,000 Administrative Penalty
Violation:  Improper denial of payment for a medical service that was preauthorized.


American Home Assurance Company of New York City, NY
Order Number: DWC-07-0091
Date of Order:  9/14/2007
Order Final In:   September
Action Taken:  $33,500 Administrative Penalty
Violation:  Issued 29 late Temporary Income Benefits for the time period April 16 - May 31, 2004


City of San Antonio of San Antonio
Order Number: DWC-07-0092
Date of Order:  9/14/2007
Order Final In:   September
Action Taken:  $15,000 Administrative Penalty
Violation:  An audit discovered numerous violations of the Texas Labor Code related to medical bill processing, reporting of medical bill data and accuracy of reporting data.


Dallas National Insurance Company of Dallas, TX
Order Number: DWC-07-0098
Date of Order:  9/28/2007
Order Final In:   September
Action Taken:  $5,000 Administrative Penalty
Violation:  Failure to timely initiate or file a writeen refusal to pay benefits with an explanation to the injured employee of their right to request a benefit review conference.


Employers Mutual Casualty Company of Des Moines, IA
Order Number: DWC-07-0103
Date of Order:  9/28/2007
Order Final In:   September
Action Taken:  $1,500 Administrative Penalty
Violation:  Improper denial of payment for a medical service that was preauthorized.


Farmers Insurance Exchange, Truck Insurance Exchange, Mid-Century Insurance Company of Austin, TX
Order Number: DWC-07-0105
Date of Order:  9/28/2007
Order Final In:   September
Action Taken:  $60,000 Administrative Penalty
Violation:  Failure to conduct on-site visits, or provide accident prevention services at least every 12 months to each policyholder.


Liberty Insurance Corporation, Liberty Mutual Insurance Company, Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC-07-1000
Date of Order:  9/28/2007
Order Final In:   September
Action Taken:  $125,000 Administrative Penalty
Violation:  Wrongful denial of preauthorized medical services.


Liberty Insurance Corporation, Liberty Mutual Insurance Company, Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC-07-0101
Date of Order:  9/28/2007
Order Final In:   September
Action Taken:  $175,000 Administrative Penalty
Violation:  An audit of the companies revealed 694 inappropriately processed preauthorized medical bills for services paid between 1/1/04 and 12/31/04.


Liberty Insurance Corporation, Liberty Mutual Insurance Company, Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC-07-0102
Date of Order:  9/28/2007
Order Final In:   September
Action Taken:  $125,000 Administrative Penalty
Violation:  Wrongful denial of preauthorized medical services.


Liberty Insurance Corporation, Liberty Mutual Insurance Company, Liberty Mutual Fire Insurance Company, Employers Insurance Company of Wausau, Wausau Business Insurance Company of Boston, MA; Wausau, WI
Order Number: DWC-07-0099
Date of Order:  9/28/2007
Order Final In:   September
Action Taken:  $50,000 Administrative Penalty
Violation:  Failure to timely provide information to substantiate the medical necessity of the heatlh care requested, failure to timely pay for services, failure to comply with a Contested Case Hearing Decision & Order, failure to timely comply with a benefit review conference interlocutory order, failure to confirm medical benefits coverage, failure to process claims promptly, failure to pay awarding benefits, unreasonably disputing the reasonableness and necessity of health care, violated commissioner rules.


American Casualty Company of Reading, PA; Continental Casualty Company; National Fire Insurance Company; Valley Forge Insurance Company; Transportation Insurance Company of Chicago, IL
Order Number: DWC-07-0076
Date of Order:  8/23/2007
Order Final In:   August
Action Taken:  $80,000 Administrative Penalty
Violation:  Failure to timely dispute payment of SIBs, failure to timely pay SIBs; failure to pay SIBs in the correct amount; failure to enclose a copy of the Application for SIBS with the SIBs payment and violation of Division rules.


Phoenix Assurance Company of NY, Connecticut Indemnity Company, Fire & Casualty Insurance Company of CT of Charlotte, NC
Order Number: DWC-07-0075
Date of Order:  8/23/2007
Order Final In:   August
Action Taken:  $8,877 Administrative Penalty
Violation:  Failure to timely pay initial Temporary Income Benefits and violation of commissioner rules.


American Safety Casualty Insurance Company of Atlanta, GA
Order Number: DWC-070064
Date of Order:  7/19/2007
Order Final In:   July
Action Taken:  $8,000 administrative penalty
Violation:  Failure to pay or refund IRO fees; failure to comply with a rule, order or decision of the Commissioner.


City of Dallas of Dallas
Order Number: DWC-070058
Date of Order:  7/17/2007
Order Final In:   July
Action Taken:  $5,000 administrative penalty
Violation:  Failure to pay, reduce, deny or audit HCP claim; failure to take timely final action on a medical bill.


Cumis Insurance Society, Inc. of Madison, WI
Order Number: DWC-070056
Date of Order:  7/17/2007
Order Final In:   July
Action Taken:  $7,500 administrative penalty
Violation:  Failure to timely comply with a rule, order, or decision of the Commissioner, specifically a Medical Dispute Resolution order.


Diamond, Howard Gregg, MD of Richardson
Order Number: DWC-070062
Date of Order:  7/19/2007
Order Final In:   July
Action Taken:  $2,500 administrative penalty
Violation:  Failure to timely file the Report of Medical Evaluation (DWC Form-069); failure to respond to Commissioner's request for clarification.


Federal Insurance Company of Warren, NJ
Order Number: DWC-070054
Date of Order:  7/17/2007
Order Final In:   July
Action Taken:  $8,000 administrative penalty
Violation:  Failure to pay, reduce/deny or audit HCP claim; failure to timely process and take final action on a medical bill; failure to timely take final action on a correctly completed request for reconsideration; failure to pay or refund IRO fees; failure to comply with a rule or decision by the Commissioner.


Florists' Mutual Insurance Company of Edwardsville, IL
Order Number: DWC-070061
Date of Order:  7/19/2007
Order Final In:   July
Action Taken:  $5,000 administrative penalty
Violation:  Failure to timely pay supplemental income benefits.


Kinzie, Daniel M.D. of Midland
Order Number: DWC-070055
Date of Order:  7/17/2007
Order Final In:   July
Action Taken:  $4,000 administrative penalty
Violation:  Failure to timely file and/or appropriately file reports, specifically the Work Status Report, DWC Form-073, failure to meet minimum compliance rates for a DWC Form-073 audit.


New Hampshire Insurance Company of Harrisburg, PA
Order Number: DWC-070057
Date of Order:  7/17/2007
Order Final In:   July
Action Taken:  $1,500 admininistrative penalty
Violation:  Failure to reduce, deny, pay or audit HCP claim; failure to take final action on a medical bill.


Sentry Insurance, A Mutual Company of Stevens Point, WI
Order Number: DWC-070063
Date of Order:  7/19/2007
Order Final In:   July
Action Taken:  $9,500 administrative penalty
Violation:  Failure to comply with a contested case hearing decision & order; failure to pay income benefits in a timely manner.


ACE Property & Casualty Ins Co, et al of Philadelphia
Order Number: DWC-070037
Date of Order:  6/5/2007
Order Final In:   June
Action Taken:  $87,727 administrative penalty
Violation:  Inappropriately processed medical bills; failure to meet the minimum compliance standard of a medical bill process audit.


Alost, Thomas E., M.D. of El Paso
Order Number: DWC-070040
Date of Order:  6/5/2007
Order Final In:   June
Action Taken:  $3,500 admininistrative penalty
Violation:  Failure to timely file and/or appropriately file reports, specifically the Work Status Report, DWC Form-073, failure to meet minimum compliance rates for a DWC Form-073 audit.


Bituminous Casualty Corporation of Rock Island, IL
Order Number: DWC-070042
Date of Order:  6/5/2007
Order Final In:   June
Action Taken:  $1,200 administrative penalty
Violation:  Failure to timely process and take action on a medical bill


Gabel, Gerard, M.D. of Houston
Order Number: DWC-070041
Date of Order:  6/5/2007
Order Final In:   June
Action Taken:  $6,000 administrative penalty
Violation:  Failure to timely file and/or appropriately file reports, specifically the Work Status Report, DWC Form-073, failure to meet minimum compliance rates for a DWC Form-073 audit.


Hernandez, Alvaro A, M.D. of El Paso
Order Number: DWC-070039
Date of Order:  6/5/2007
Order Final In:   June
Action Taken:  $3,000 administrative penalty
Violation:  Failure to timely file and/or appropriately file reports, specifically the Work Status Report, DWC Form-073, failure to meet minimum compliance rates of a DWC Form-073 audit.


Old Republic Insurance Company of Greensburg, PA
Order Number: DWC-070038
Date of Order:  6/5/2007
Order Final In:   June
Action Taken:  $1,000 administrative penalty
Violation:  Failure to initiate temporary income benefits during the required time period.