Division of Workers’ Compensation Announces March Enforcement Actions
AUSTIN – 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 MARCH 2011 (alphabetical order)
Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-11-0028
Date of Order: 3/3/2011
Order Final In: March
Action Taken: Fined $48,000
Violation: Failed to comply with order or decision of Commissioner or TDI-DWC; Failed to timely pay income benefits to injured employee; Failed to pay for preauthorized medical services; Failed to timely act on request for reconsideration of a medical bill
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: DWC110040
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: DWC110027
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: DWC110043
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: DWC110031
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 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: DWC110034
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: DWC110029
Date of Order: 3/3/2011
Order Final In: March
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports or records
Houston Northwest Emergency Specialists, PLLC of Houston
Order Number: DWC110039
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: DWC110036
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: DWC110037
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: DWC110038
Date of Order: 3/7/2011
Order Final In: March
Action Taken: Fined $5,000
Violation: Filed unwarranted complaints against system participants
Source: TDI-DWC