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.
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 JANUARY 2010 (alphabetical order)
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 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 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 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 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 TDI-DWC forms, reports or records
Knoll, Victoria D., M.D. of Plano
Order Number: DWC-110002
Date of Order: 1/10/2011
Order Final In: January
Action Taken: Fined $1,000;
Violation: Failed to timely file and/or accurately complete 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 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 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 TDI-DWC or accurately submit benefit data by electronic data interchange; Failed to timely pay attorney fees
For more information contact: PIO@tdi.state.tx.us
Source: tdi.state.tx.us