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 MAY 2011 (alphabetical order)
American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC11-0057
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 TDI-DWC; Failed to timely reimburse injured employee for travel expenses
Gibbons, Raymond Robert M.D. of Dallas
Order Number: DWC11-0055
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: DWC11-0053
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 and payment data
Hartford Casualty Insurance Corporation of Hartford, CT
Order Number: DWC11-0060
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: DWC11-0054
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 injured employee
New Hampshire Insurance Company of New York, NY
Order Number: DWC11-0056
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: DWC11-0059
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: DWC11-0058
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 TDI-DWC
XL Insurance America Inc. of Exton, PA
Order Number: DWC11-0061
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: DWC11-0052
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
Source: TDI-DWC