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) in November and December 2011.
The final actions include orders related to violations of the Texas Labor Code and rules promulgated by the Commissioner of Workers’ Compensation. Violations cited in orders naming insurers included failure to timely pay a medical bill and failure to timely pay income benefits to an injured employee. Violations cited in orders naming health care providers included failure to timely file and/or accurately complete TDI-DWC forms, reports or records.
AAA Cooper Transportation of Dothan, AL
Order Number: DWC-11-0115
Date of Order: 12/6/2011
Order Final In: December
Action Taken: Fined $9,000
Violation: Failed to timely pay income benefits to injured employee; Failed to accurately submit medical bill and payment data
Castlepoint National Insurance Company of New York, NY
Order Number: DWC-11-0125
Date of Order: 12/22/2011
Order Final In: December
Action Taken: Fined $10,000 with a dollar-for-dollar reduction of up to $4,650 for refunds paid to policyholders
Violation: Improperly charged policyholders for providing accident prevention services
Dallas National Insurance Company, A Texas Stock Insurance Company of Dallas
Order Number: DWC-11-0119
Date of Order: 12/15/2011
Order Final In: December
Action Taken: Fined $100,000
Violation: Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to timely pay income benefits to injured employee
El Paso County of El Paso
Order Number: DWC-11-0120
Date of Order: 12/16/2011
Order Final In: December
Action Taken: Fined $2,500
Violation: Failed to comply with order or decision of Commissioner or TDI-DWC
Ennis, Gregory P., M.D. of Irving
Order Number: DWC-11-0121
Date of Order: 12/16/2011
Order Final In: December
Action Taken: Fined $1,500; 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
McWatt, Gordon G., D.O. of Aledo
Order Number: DWC-11-0124
Date of Order: 8/5/2011
Order Final In: December
Action Taken: Fined $15,000
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports or records
Nguyen, Quoc Thai D.C. of Houston
Order Number: DWC-11-0127
Date of Order: 12/22/2011
Order Final In: December
Action Taken: Fined $2,500; Must complete approved continuing education hours
Violation: Failed to practice medicine or provide health care consistent with public health, safety and welfare
Orlov, Alexander D.O. of Lufkin
Order Number: DWC-11-0116
Date of Order: 12/9/2011
Order Final In: December
Action Taken: Removed from workers’ compensation system as health care practitioner and deleted from Designated Doctor List.
Violation: Criminal offense
Texas Mutual Insurance Company of Austin
Order Number: DWC-11-0114
Date of Order: 12/6/2011
Order Final In: December
Action Taken: Fined $10,000
Violation: Failed to timely pay an order to pay attorney’s fees; Failed to comply with a TDI-DWC order; Failed to provide opposing party a letter of clarification
Tower National Insurance Company of New York, NY
Order Number: DWC-11-0126
Date of Order: 12/22/2012
Order Final In: December
Action Taken: Fined $36,000 with a dollar-for-dollar reduction of up to $30,200 for refunds paid to policyholders
Violation: Improperly charged policyholders for providing accident prevention services
Dallas Independent School District of Dallas
Order Number: DWC-11-0111
Date of Order: 11/3/2011
Order Final In: November
Action Taken: Fined $3,500
Violation: Failed to accurately submit medical bill and payment data
Dallas National Insurance Company, A Texas Stock Insurance Company of Dallas
Order Number: DWC-11-0110
Date of Order: 11/3/2011
Order Final In: November
Action Taken: Fined $20,000
Violation: Failed to timely pay income benefits to injured employee; Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to pay an order awarding benefits; Failed to comply with order or decision of Commissioner; Failed to timely pay attorney’s fees
Hidalgo County of Edinburg
Order Number: DWC-11-0113
Date of Order: 11/3/2011
Order Final In: November
Action Taken: Fined $7,500
Violation: Failed to timely pay income benefits to injured employee; Failed to timely notify TDI-DWC on actions taken on a claim
Lubbock Heritage Hospital, L.L.C. d/b/a Grace Medical Center of Lubbock
Order Number: DWC-11-0105
Date of Order: 11/3/2011
Order Final In: November
Action Taken: Fined $3,000
Violation: Improperly billed an injured employee for workers’ compensation medical services provided
McShane, Ricky Michael D.O. of Deer Park
Order Number: DWC-11-0107
Date of Order: 11/3/2011
Order Final In: November
Action Taken: Fined $10,000; 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; Failed to timely file letter of clarification
National Interstate Insurance Company of Richfield, OH
Order Number: DWC-11-0106
Date of Order: 11/3/2012
Order Final In: November
Action Taken: Fined $3,000
Violation: Failed to timely file Accident Prevention Services Report; Failed to timely provide investigation documentation relating to compensability of a death
Netherlands Insurance Company of Boston, MA
Order Number: DWC-11-0112
Date of Order: 11/3/2011
Order Final In: November
Action Taken: Fined $8,500
Violation: Failed to timely report termination of death benefits
Texas Builders Insurance Company of Austin
Order Number: DWC-11-0109
Date of Order: 11/3/2011
Order Final In: November
Action Taken: Fined $25,000
Violation: Failed to maintain or provide accident prevention services and facilities; Failed to provide mandatory on-site visits to certain policyholders
Ullico Casualty Company of Washington, D.C.
Order Number: DWC-110108
Date of Order: 11/3/2011
Order Final In: November
Action Taken: Fined $8,500
Violation: Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to timely submit medical bill and payment data to the Division
Summaries of disciplinary actions are available on the TDI website at: https://wwwapps.tdi.state.tx.us/inter/asproot/commish/da/dwcclips2011.asp.
Source: TDI-DWC