September 26, 2017

Division of Workers’ Compensation Announces November Enforcement Actions

AUSTIN, TX – Commissioner of Workers’ Compensation Rod Bordelon recently announced final disciplinary actions taken by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC). The final actions include orders related to violations of the Texas Labor Code and rules promulgated by the Commissioner of Workers’ Compensation.  Commissioner’s orders are subject to appeal to state district court within 30 days after being issued.

Copies of Commissioner of Workers’ Compensation orders may be obtained by calling Maria Jimenez, TDI-DWC Enforcement, at 512-804-4703 or via e-mail to Maria.Jimenez@tdi.state.tx.us.

DIVISION OF WORKERS’ COMPENSATION

FINAL DISCIPLINARY ORDERS FOR NOVEMBER 2010 (alphabetical order)

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
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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
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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 TDI-DWC compliance audit in FY2011
Violation:  Failed to timely pay TIBs; Failed to submit accurate data to TDI-DWC
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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 TDI-DWC or Commissioner Order
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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
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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 TDI-DWC; Failed to timely take final action on a request for reconsideration of a medical bill
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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 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
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Elliston, Bruce M.D. of Addsion
Order Number: DWC100114
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
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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 TDI-DWC or Commissioner Order
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Fidelity & Guaranty Insurance Company of Saint Paul, MNOrder 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
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Khan, Rashid M.D. of Houston
Order Number: DWC100112
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
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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
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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
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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
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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 TDI-DWC or Commissioner Order
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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
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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 TDI-DWC; Failed to pay attorney fees as ordered by TDI-DWC
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Stuart, John Robert M.D. of Dallas
Order Number: DWC100106
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
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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 TDI-DWC; Failed to timely pay or deny a request for reimbursement submitted by injured employee
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Westfield Insurance Company of Westfield 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
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Zurich American Insurance Company of Schaumberg, 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 TDI-DWC’s fee guidelines medical policies; Failed to sufficiently explain reasons for the reduction or denial of payment for health care services
For more information contact: PIO@tdi.state.tx.us

Last updated: 12/15/2010

Source:  TDI DWC

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