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.
AAA Cooper Transportation of Dothan, AL
Order Number: DWC-2730
Date of Order: 8/30/2013
Order Final In: August
Action Taken: Fined $5,000
Violation: Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange
ACIG Insurance Company of Dallas
Order Number: DWC-2682
Date of Order: 8/2/2013
Order Final In: August
Action Taken: Fined $10,000
Violation: Failed to timely pay income benefits to injured employee
Bangale, Anil T., M.D. of Fort Worth
Order Number: DWC-2680
Date of Order: 8/2/2013
Order Final In: August
Action Taken: Fined $5,000
Violation: Quality of health care provided not in compliance with statutory requirements; Failed to report a disciplinary action on Designated Doctor application
Burke, Douglas William D.C. of San Antonio
Order Number: DWC-2709
Date of Order: 8/23/2013
Order Final In: August
Action Taken: Fined $5,000; Must complete continuing education course on following medical guidelines
Violation: Provided treatment not in accord with applicable treatment guidelines and not within the standard of care
East Texas Educational Insurance Association of Tyler
Order Number: DWC-2710
Date of Order: 8/23/2013
Order Final In: August
Action Taken: Fined $2,000
Violation: Failed to timely report medical electronic data interchange (EDI) records to TDI-DWC
Ebeade, Samir S., M.D. of Orange
Order Number: DWC-2720
Date of Order: 8/26/2013
Order Final In: August
Action Taken: Must cease designated doctor examinations at a specific location and must request the location for examinations be deleted from TDI-DWC system
Violation: Failed to use a properly equipped medical facility for designated doctor examinations
El Paso County Hospital District of El Paso
Order Number: DWC-2708
Date of Order: 8/23/2013
Order Final In: August
Action Taken: Fined $11,000
Violation: Failed to accurately and timely submit electronic data interchange (EDI) records to TDI-DWC
Florists’ Mutual Insurance Company of Edwardsville, IL
Order Number: DWC-2707
Date of Order: 8/23/1013
Order Final In: August
Action Taken: Fined $2,500
Violation: Failed to accurately submit medical bill and payment data
Harlandale Independent School District of San Antonio
Order Number: DWC-2724
Date of Order: 8/28/2013
Order Final In: August
Action Taken: Fined $4,000
Violation: Failed to timely comply with a TDI-DWC order
Kestler, Bryan Claude D.C. of Port Lavaca
Order Number: DWC-2718
Date of Order: 8/26/2013
Order Final In: August
Action Taken: Fined $1,000
Violation: Failed to comply with Texas Workers’ Compensation Act
ORR, Inc. of Texarkana
Order Number: DWC-2681
Date of Order: 8/2/2013
Order Final In: August
Action Taken: Fined $1,000
Violation: Failed to comply with Commissioner’s Order to provide requested information about workers’ compensation coverage status
West Rest Haven, Inc. of West
Order Number: DWC-2725
Date of Order: 8/28/2013
Order Final In: August
Action Taken: Fined $1,000
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports, or records
Amerisure Partners Insurance Company of Farmington Hills, MI
Order Number: DWC-2651
Date of Order: 7/17/2013
Order Final In: July
Action Taken: Fined $13,500
Violation: Failed to accurately submit medical bill and payment data to TDI-DWC
Bates, Aaron M.D. of Fleming Island, FL
Order Number: DWC-2649
Date of Order: 7/17/2013
Order Final In: July
Action Taken: Permanently cease from participating or practicing in Texas workers’ compensation system
Violation: Failed to appropriately evaluate injured employee assigned
El Paso County Community College of El Paso
Order Number: DWC-2656
Date of Order: 7/17/2013
Order Final In: July
Action Taken: Fined $6,000
Violation: Failed to accurately submit medical bill and payment data to TDI-DWC
GuideOne Mutual Insurance Company of West Des Moines, IA
Order Number: DWC-2678
Date of Order: 7/30/2013
Order Final In: July
Action Taken: Fined $10,000
Violation: Failed to accurately report electronic data interchange (EDI) medical billing data to TDi-DWC
Labrock Materials, Inc. of Euless, TX
Order Number: DWC-2667
Date of Order: 7/25/2013
Order Final In: July
Action Taken: Fined $5,000
Violation: Failed to timely comply with Commissioner’s Order to provide requested information about workers’ compensation coverage status
MacMaster, Benzel Christopher M.D. of Dallas
Order Number: DWC-2655
Date of Order: 7/17/2013
Order Final In: July
Action Taken: Fined $2,000
Violation: Failed to adequately document required information in a peer review report
Markel Insurance Company of Glen Allen, VA
Order Number: DWC-2652
Date of Order: 7/17/2013
Order Final In: July
Action Taken: Fined $4,500
Violation: Failed to timely pay income benefits to injured employee; Failed to notify TDI-DWC and injured employee of actions taken on a claim
Protective Insurance Company of Indianapolis, IN
Order Number: DWC-2665
Date of Order: 7/25/2013
Order Final In: July
Action Taken: Fined $30,000
Violation: Failed to provide required claims experience and documentation of loss analysis to policyholders
Texas Mutual Insurance Company of Austin
Order Number: DWC-2666
Date of Order: 7/25/2013
Order Final In: July
Action Taken: Fined $6,500
Violation: Failed to timely pay an advance ordered by TDI-DWC; Failed to timely provide injured employee records to designated doctor; Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange
Tower National Insurance Company of New York, NY
Order Number: DWC-2650
Date of Order: 7/17/2013
Order Final In: July
Action Taken: Fined $10,000
Violation: Failed to accurately submit medical bill and payment data to TDI-DWC
U.S. Toxicology L.L.C. of Dallas
Order Number: DWC-2671
Date of Order: 7/26/2013
Order Final In: July
Action Taken: Fined $4,000
Violation: Failed to comply with TDI-DWC order
Walmart Associates Inc. of Bentonville, AR
Order Number: DWC-2673
Date of Order: 7/26/2013
Order Final In: July
Action Taken: Fined $2,500
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports, or records
Walmart Associates, Inc. of Bentonville, AR
Order Number: DWC-2672
Date of Order: 7/26/2013
Order Final In: July
Action Taken: Fined $4,000
Violation: Failed to timely pay indemnity benefits
Wausau Underwriters Insurance Company of Boston, MA
Order Number: DWC-2654
Date of Order: 7/17/2013
Order Final In: July
Action Taken: Fined $8,000
Violation: Failed to timely comply with a TDI-DWC order; Failed to timely pay accrued income benefits following receipt of designated doctors report
Znat Insurance Company of Woodland Hills, CA
Order Number: DWC-2653
Date of Order: 7/17/2013
Order Final In: July
Action Taken: Fined $11,500
Violation: Failed to timely pay income benefits to injured employee; Failed to notify TDI-DWC and injured employee of actions taken on a claim
Center for Injured Workers, Inc. of San Antonio
Order Number: DWC-2551
Date of Order: 5/28/2013
Order Final In: June
Action Taken: SOAH DOCKET No. 452-12-1463.C1. Fined $4,000.
Violation: As non-attorney representative, improperly received fee from workers’ compensation claimant
Chubb Indemnity Insurance Company of Warren, NJ
Order Number: DWC-2598
Date of Order: 6/17/2013
Order Final In: June
Action Taken: Fined $7,000
Violation: Failed to timely pay income benefits to injured employee
Desert Imaging Services L.P. of El Paso
Order Number: DWC-2615
Date of Order: 6/27/2013
Order Final In: June
Action Taken: Fined $6,000
Violation: Improperly billed an injured employee for workers’ compensation services provided
Employers Preferred Insurance Company of Reno, NV
Order Number: DWC-2597
Date of Order: 6/17/2013
Order Final In: June
Action Taken: Fined $7,000
Violation: Failed to timely pay income benefits to injured employee; Failed to notify TDI-DWC of action taken on a claim
Indemity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-2558
Date of Order: 6/3/2013
Order Final In: June
Action Taken: Fined $15,000
Violation: Failed to comply with TDI-DWC rule and order; Failed to timely pay income benefits to injured employee; Failed to timely pay medical bill or to pay medical bill according to TDI-DWC Medical Fee Guidelines
Mussaji, Murtaza D. O. of Houston
Order Number: DWC-2559
Date of Order: 6/3/2013
Order Final In: June
Action Taken: Designated doctor reports to be monitored by TDI-DWC; Random sample of cases to be subject to medical quality review with fees to be paid by doctor
Violation: Failed to perform complete medical examination of injured employee; Failed to utilize guidelines for return to work; Failed to document analysis of injured worker to determine maximum medical improvement
Reichert, Oscar M., D.O. of Mount Pleasant
Order Number: DWC-2557
Date of Order: 6/3/2013
Order Final In: June
Action Taken: Must timely complete specified training
Violation: Provided treatment which did not promote recovery and/or enhance the ability of injured employee to return to work in timely manner
Source: TDI-DWC