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. 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.
Albrand, Otmar Wolf M.D. of Kyle
Order Number: DWC-12-0171
Date of Order: 10/12/2012
Order Final In: October
Action Taken: Suspended from Designated Doctor List
Violation: Failed to perform additional relevant testing or to refer injured employee to other health care providers to determine medical issue; Improperly determined impairment rating
American Hardware Mutual Insurance Company of Columbus, OH
Order Number: DWC-12-0178
Date of Order: 10/17/2012
Order Final In: October
Action Taken: Fined $3,000
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports or records
Baker, Gregory Wayne D.C. of Pasadena
Order Number: DWC-12-0174
Date of Order: 10/17/2012
Order Final In: October
Action Taken: Removed from Designated Doctor List; Deprived of right to certify maximum medical improvement and/or assign impairment ratings in the workers’ compensation system
Violation: Performed a designated doctor examination without appointment from TDI-DWC
Bradford Holding Company, Inc. of Corpus Christi
Order Number: DWC-12-0183
Date of Order: 10/29/2012
Order Final In: October
Action Taken: Fined $21,000
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
Capitol City Insurance Company of New York, NY
Order Number: DWC-12-0169
Date of Order: 10/12/2012
Order Final In: October
Action Taken: Fined $2,500
Violation: Failed to notify TDI-DWC and injured employee of actions taken on a claim; Failed to accurately submit medical bill and payment data
City of Arlington of Arlington
Order Number: DWC-12-0177
Date of Order: 10/17/2012
Order Final In: October
Action Taken: Fined $11,500
Violation: Failed to accurately submit medical bill and payment data
Dish Network Corporation of Conroe
Order Number: DWC-12-0167
Date of Order: 10/5/2012
Order Final In: October
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
Hartford Insurance Company of the Midwest of Hartford, CT
Order Number: DWC-12-0186
Date of Order: 10/29/2012
Order Final In: October
Action Taken: Fined $5,000
Violation: Failed to accurately submit medical bill and payment data
Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-12-0185
Date of Order: 10/29/2012
Order Final In: October
Action Taken: Fined $6,960
Violation: Failed to accurately submit medical bill and payment data
Lumbermen’s Underwriting Alliance of Boca Raton, FL
Order Number: DWC-12-0184
Date of Order: 10/29/2012
Order Final In: October
Action Taken: Fined $4,600
Violation: Failed to accurately submit medical bill and payment data
Meridian Security Insurance Company of Indianapolis, IN
Order Number: DWC-12-0176
Date of Order: 10/17/2012
Order Final In: October
Action Taken: Fined $34,300
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
National American Insurance Company of Chandler, OK
Order Number: DWC-12-0187
Date of Order: 10/29/2012
Order Final In: October
Action Taken: Fined $5,760
Violation: Failed to accurately submit medical bill and payment data
Petroleum Casualty Company of Austin
Order Number: DWC-12-0188
Date of Order: 10/29/2012
Order Final In: October
Action Taken: Fined $2,400
Violation: Failed to accurately submit medical bill and payment data
Praetorian Insurance Company of New York, NY
Order Number: DWC-12-0170
Date of Order: 10/12/2012
Order Final In: October
Action Taken: Fined $30,000
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
Soignier, Wayne A., M.D. of Kyle
Order Number: DWC-12-0173
Date of Order: 10/17/2012
Order Final In: October
Action Taken: Permanently removed from designated doctor list
Violation: Failed to perform TDI-DWC ordered designated doctor examinations in accordance with AMA Guidelines; Submitted inaccurate or incomplete reports; Failed to follow statutes and rules for designated doctor appointments and reporting to TDI-DWC
Southern Vanguard Insurance Company of Dallas
Order Number: DWC-12-0166
Date of Order: 10/5/2012
Order Final In: October
Action Taken: Fined $15,500
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
Sparta Insurance Company of Hartford, CT
Order Number: DWC-12-0168
Date of Order: 10/5/2012
Order Final In: October
Action Taken: Fined $9,500
Violation: Failed to timely pay income benefits to injured employee
Texas A & M University of College Station
Order Number: DWC-12-0165
Date of Order: 10/5/2012
Order Final In: October
Action Taken: Fined $3,000
Violation: Failed to timely pay income benefits to injured employee; Failed to timely or accurately report dates for first notice, disability, and initial payment
Texas Builders Insurance Company of Austin
Order Number: DWC-12-0172
Date of Order: 10/17/2012
Order Final In: October
Action Taken: Fined $2,500
Violation: Failed to accurately submit medical bill and payment data
Transguard Insurance Company of America, Inc. of Naperville, IL
Order Number: DWC-12-0175
Date of Order: 10/17/2012
Order Final In: October
Action Taken: Fined $1,000
Violation: Failed to timely file accident prevention services annual report for calendar year 2011
Vanliner Insurance Company of St. Louis, MO
Order Number: DWC-12-0179
Date of Order: 10/17/2012
Order Final In: October
Action Taken: $17,000
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
Vredenburgh, Jesse William D.O. of Corpus Christi
Order Number: DWC-12-0182
Date of Order: 10/23/2012
Order Final In: October
Action Taken: Fined $5,000; Suspended from designated doctors list for one year
Violation: Failed to comply with order or decision of Commissioner or TDI-DWC
Source: TDI-DWC