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, failure to timely pay income benefits to an injured employee, and retrospectively reviewing the medical necessity of a preauthorized medical service or treatment. Violations cited in orders naming health care providers included failure to timely file and/or accurately complete TDI-DWC forms, reports or records.
American Home Assurance Company of New York, NY
Order Number: DWC-2301
Date of Order: 2/20/2013
Order Final In: February
Action Taken: Fined $2,000
Violation: Inappropriately required preauthorization of prescription drugs on a non-network legacy claim
Andrew, John Gray M.D. of Friendswood
Order Number: DWC-2322
Date of Order: 2/28/2013
Order Final In: February
Action Taken: Must complete assessment of practice to determine need for education plan.
Violation: Failed to meet requirements for performing and documenting examinations of injured workers to determine impairment ratings
Argonaut-Southwest Insurance Company of San Antonio
Order Number: DWC-2318
Date of Order: 2/28/2013
Order Final In: February
Action Taken: Fined $24,000
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
Burnet 1 Enterprises L.L.C. D/B/A Oaks Nursing Center of Burnet
Order Number: DWC-2310
Date of Order: 2/22/2013
Order Final In: February
Action Taken: Fined $600
Violation: Failed to comply with Commissioner’s Order to provide requested information about workers’ compensation coverage status
Clear Lake Regional Medical Center of Louisville, KY
Order Number: DWC-2325
Date of Order: 2/28/2013
Order Final In: February
Action Taken: Fined $2,500
Violation: Improperly billed an injured employee for workers’ compensation medical services provided
Douglas, Howard Thomas III, M.D. of Corinth
Order Number: DWC-2319
Date of Order: 2/28/2013
Order Final In: February
Action Taken: Removed from designated doctor list
Violation: Performed designated doctor examination when not appointed by TDI-DWC or by mutual agreement of the parties
Fallon, Michael A., M.D. of El Paso
Order Number: DWC-2316
Date of Order: 2/27/2013
Order Final In: February
Action Taken: Fined $6,000
Violation: Failed to timely provide medical records of an injured employee after being ordered to produce them
Houston Independent School District of Houston
Order Number: DWC-2326
Date of Order: 2/28/2013
Order Final In: February
Action Taken: Fined $5,000
Violation: Failed to timely pay income benefits to injured employee
Johnson, George Howell, Sr., D.O. of Deer Park
Order Number: DWC-2320
Date of Order: 2/28/2013
Order Final In: February
Action Taken: Designated doctor reports must be monitored by TDI-DWC for one year
Violation: Failed to meet requirements for performing and documenting examination of injured worker to determine maximum medical improvement
Kennedy, Charles W., Jr., M.D. of Corpus Christi
Order Number: DWC-2323
Date of Order: 2/28/2013
Order Final In: February
Action Taken: Must complete a medical record-keeping course and submit reports of designated doctor examinations to TDI-DWC for monitoring
Violation: Failed to adequately document medical evaluations and assign impairment ratings
Oberoi, Asra M.D. of Dallas
Order Number: DWC-2324
Date of Order: 2/28/2013
Order Final In: February
Action Taken: Will not be assigned designated doctor examinations, MMI, or IR ratings examinations until new certification is approved
Violation: Failed to identify specific findings in impairment analysis and failed to recognize the statutory maximum medical improvement date
PF&B Management, GP L.L.C. of Houston
Order Number: DWC-2304
Date of Order: 2/20/2013
Order Final In: February
Action Taken: Fined $1,000
Violation: Failed to comply with Commissioner’s Order to provide requested information about workers’ compensation coverage status
Philbrick, Darey Allen M.D. of Kyle
Order Number: DWC-2327
Date of Order: 2/28/2013
Order Final In: February
Action Taken: Removed from Texas workers’ compensation system as a health care practitioner
Violation: Medical license cancelled
Third Coast Fresh Distribution L.L.C. of Houston
Order Number: DWC-2314
Date of Order: 2/27/2013
Order Final In: February
Action Taken: Fined $500
Violation: Failed to comply with Commissioner’s Order to provide requested information about workers’ compensation coverage status
Ullico Casualty Company of Washington, D.C.
Order Number: DWC-2303
Date of Order: 2/20/2013
Order Final In: February
Action Taken: Fined $55,000
Violation: Failed to timely pay income benefits to injured employee; Failed to timely process medical bills; Failed to timely report benefit data toTDI- DWC or accurately submit benefit data by electronic data interchange; Failed to timely file DWC EDI-03 forms; Failed to pay for services that were preauthorized; Failed to timely process a preauthorization request; and Failed to timely file its accident prevention services annual report
Viesca, Carlos O., M.D. of El Paso
Order Number: DWC-2315
Date of Order: 2/27/2013
Order Final In: February
Action Taken: Fined $6,000
Violation: Failed to timely provide medical records of an injured employee after being ordered to produce them
Wiggins, Joe W., D.C. of Canyon Lake
Order Number: DWC-2321
Date of Order: 2/28/2013
Order Final In: February
Action Taken: Must complete AADEP course; Certification of maximum medical improvement and assignment of impairment ratings for injured workers must be monitored by TDI-DWC for one year
Violation: ?? Attorneys please summarize
American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-2201
Date of Order: 1/18/2013
Order Final In: January
Action Taken: Fined $4,000
Violation: Failed to timely pay income benefits to injured employee; Failed to timely comply with a TDI-DWC order
Design Transportation Services Inc. of Dallas
Order Number: DWC-2231
Date of Order: 1/25/2013
Order Final In: January
Action Taken: Fined $3,000
Violation: Failed to comply with Commissioner’s Order to provide requested information about workers’ compensation coverage status
Farmers Insurance Exchange of Austin
Order Number: DWC-2200
Date of Order: 1/18/2013
Order Final In: January
Action Taken: Fined $3,000
Violation: Failed to provide on-site visit or other appropriate services at least every 12 months for policyholders
Federal Insurance Company of Warren, NJ
Order Number: DWC-2202
Date of Order: 1/18/2013
Order Final In: January
Action Taken: Fined $36,000
Violation: Failed to timely pay income benefits to injured employee; Failed to accurately provide benefit payment and medical bill data
Kirkwood, John Dale D.O. of Pasadena
Order Number: DWC-2241
Date of Order: 1/30/2013
Order Final In: January
Action Taken: Fined $4,000
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports or records
Lightner, Oscar N., M.D. of Laredo
Order Number: DWC-2240
Date of Order: 1/30/2013
Order Final In: January
Action Taken: Fined $7,000
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports or records
Mid-Century Insurance Company of Austin
Order Number: DWC-2198
Date of Order: 1/18/2013
Order Final In: January
Action Taken: Fined $14,360
Violation: Failed to accurately submit medical bill data to TDI-DWC via electronic data interchange; Failed to provide on-site visit or other appropriate services for policyholders
National Interstate Insurance Company of Richfield, OH
Order Number: DWC-2230
Date of Order: 1/25/2013
Order Final In: January
Action Taken: Fined $23,000
Violation: Failed to timely pay or deny medical bills and to accurately and/or timely submit reports to TDI-DWC
Shell US Hosting Company of Houston
Order Number: DWC-2171
Date of Order: 1/8/2013
Order Final In: January
Action Taken: Fined $2,500
Violation: Failed to comply with Commissioner’s Order to provide requested information about workers’ compensation coverage status
Sonic Advantage P.A., L.P. of Houston
Order Number: DWC-2170
Date of Order: 1/8/2013
Order Final In: January
Action Taken: Fined $750
Violation: Failed to comply with Commissioner’s Order to provide requested information about workers’ compensation coverage status
Texas Automobile Dealers Self Insurers Group of Austin
Order Number: DWC-2186
Date of Order: 1/11/2013
Order Final In: January
Action Taken: Fined $15,000
Violation: Failed to accurately submit medical bill and payment data to TDI-DWC
Truck Insurance Exchange of Austin
Order Number: DWC-2199
Date of Order: 1/18/2013
Order Final In: January
Action Taken: Fined $13,120
Violation: Failed to accurately submit medical bill data to TDI-DWC via electronic data interchange; Failed to provide on-site visit or other appropriate services for policyholders
Source: TDI-DWC