Enforcement Actions - Texas Department of Insurance - Division of Workers' Compensation

https://wwwapps.tdi.state.tx.us/inter/asproot/commish/da/dwcclips2011.asp

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TEXAS DEPARTMENT OF INSURANCE

Division of Workers' Compensation

A Commissioner of Workers' Compensation consent order imposing disciplinary measures becomes final upon signature of the Commissioner of Workers' Compensation. If a Commissioner of Workers' Compensation disciplinary measure is appealed to the State Office of Administrative Hearings (SOAH), an Administrative Law Judge may issue a final decision and order. Final SOAH orders are subject to appeal within 30 days to state district court. If an appeal has not been made within 30 days, the SOAH order becomes final. Copies of Commissioner of Workers' Compensation orders may be obtained by calling Maria Jimenez at 512-804-4703 or via e-mail to Maria.Jimenez@tdi.state.tx.us. Please indicate Disciplinary Orders in the subject line of the request. Summaries of the orders follow.

DISCIPLINARY ORDERS POSTED for 2011

Disciplinary Orders Posted for 2010 | Disciplinary Orders Posted for 2009 | Disciplinary Orders Posted for 2008 | Disciplinary Orders Posted for 2007 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 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 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 TDI-DWC

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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 a and payment data ; Failed to comply with order or decision of Commissioner or TDI-DWC; Failed to timely reimburse inju 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 m 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 TDI-DWC; Failed to accurately submit medical bill 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 TDI-DWC; Failed to timely pay income benefits to 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

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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 s 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 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 examin 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 im 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 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

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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 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 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 certificati Violation: Failed to assign Impairment Ratings in accordance with the American Medical Association Guides to Permane

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 do 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 d Violation: Failed to timely file letter of clarification; Failed to timely file and/or accurately complete TDI-DWC forms, repo

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; notification of loss analysis; Failed to provide mandatory on-site visit to policyholders

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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 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 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 pr 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 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

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Date of Order: 2/21/2011 Order Final In: February Action Taken: Fined $3,000 Violation: Failed to comply with Commissioners 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 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 emplo request for reconsideration of a medical bill; Failed to accurately report benefit data to TDI-DWC or accurately submit ben 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 O according to TDI-DWC Medical Fee Guidelines; Failed to accurately report benefit data to TDI-DWC or accurately submit interchange; Failed to timely act on request for reconsideration of a medical bill; Failed to pay for preauthorized medical s

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