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. 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.
Benchmark Insurance Company of Eden Prairie, MN
Order Number: DWC-12-0159
Date of Order: 9/26/2012
Order Final In: September
Action Taken: Fined $5,000
Violation: Failed to provide on-site visit or other appropriate services to policyholders with $25,000 or more in premium
Berkshire Hathaway Homestate Insurance Company of San Francisco, CA
Order Number: DWC-12-0163
Date of Order: 9/26/2012
Order Final In: September
Action Taken: Fined $14,760
Violation: Failed to accurately and timely submit medical bill data
Brown, George Erwin, Jr., M.D. of Deer Park
Order Number: DWC-12-0161
Date of Order: 9/26/2012
Order Final In: September
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports or records; Failed to comply with order or decision of Commissioner or TDI-DWC
Castlepoint National Insurance Company of Chicago, IL
Order Number: DWC-12-0157
Date of Order: 9/26/2012
Order Final In: September
Action Taken: Fined $12,000
Violation: Failed to provide on-site visit or other appropriate services to policyholders with $25,000 or more in premium; Failed to provide written solicitation of comments from each policyholder at least every 12 months
City of Amarillo of Amarillo
Order Number: DWC-12-0156
Date of Order: 9/26/2012
Order Final In: September
Action Taken: Fined $10,000
Violation: Failed to accurately submit medical bill and payment data; Failed to timely pay medical bill or to pay medical bill according to TDI-DWC Medical Fee Guidelines
Clarendon National Insurance Company of New York, NY
Order Number: DWC-12-0162
Date of Order: 11/6/2012
Order Final In: September
Action Taken: Fined $12,500
Violation: Failed to timely pay medical bill or to pay medical bill according to TDI-DWC Medical Fee Guidelines; Failed to accurately submit medical bill and payment data
Sentry Insurance, A Mutual Company of Stevens Point, WI
Order Number: DWC-12-0160
Date of Order: 9/26/2012
Order Final In: September
Action Taken: Fined $13,750
Violation: Failed to timely pay income benefits to injured employee; Failed to accurately submit medical bill and payment data
Small Bone Innovations, Inc. of New York, NY
Order Number: DWC-12-0153
Date of Order: 9/10/2012
Order Final In: September
Action Taken: Fined $3,000
Violation: Misused the name of TDI-DWC
Soignier, Wayne M., M.D. of Dallas
Order Number: DWC-12-0154
Date of Order: 9/14/2012
Order Final In: September
Action Taken: Prohibited from providing health care in the Texas workers compensation system, including serving as a designated doctor
Violation: Exhibited a professional failure to practice medicine in an acceptable manner consistent with public health, safety and welfare; Submitted inaccurate or inappropriate reports as a pattern of practice due to insufficient examination and analysis of medical records
Tower National Insurance Company of New York City, NY
Order Number: DWC-12-0158
Date of Order: 9/20/2012
Order Final In: September
Action Taken: Fined $5,000
Violation: Failed to provide on-site visit or other appropriate services to policyholders with $25,000 or more in premium; Failed to provide written solicitation of comments from each policyholder at least every 12 months
Source: TDI-DWC