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.
Adair Grain Company of West
Order Number: DWC-2789
Date of Order: 9/30/2013
Order Final In: September
Action Taken: Fined $500
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports or records
American Hallmark Insurance Company of Texas of Austin
Order Number: DWC-2736
Date of Order: 9/5/2013
Order Final In: September
Action Taken: Fined $6,000
Violation: Failed to accurately submit medical records via electronic data interchange
Chadadeh, Hassan M.D. of Houston
Order Number: DWC-2735
Date of Order: 9/5/2013
Order Final In: September
Action Taken: Fined $5,000; Must complete physician assessment and clinical education course (PACE)
Violation: Failed to sufficiently document justification for prescriptions
Dallas National Insurance Company of Dallas
Order Number: DWC-2767
Date of Order: 9/17/2013
Order Final In: September
Action Taken: Fined $12,500
Violation: Failed to timely pay income benefits and accrued interest to an injured employee according to a contested case hearing decision and order
MedRisk, Inc. of King of Prussia, PA
Order Number: DWC-2746
Date of Order: 9/12/2013
Order Final In: September
Action Taken: Fined $17,500
Violation: Failed to remit full amount reimbursed by the insurance carrier to the health care provider
Pacific Indemnity Company of Warren, NJ
Order Number: DWC-2766
Date of Order: 9/17/2013
Order Final In: September
Action Taken: Fined $17,500
Violation: Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange; Failed to timely pay income benefits to injured employee
Retailers Casualty Insurance Company of Alexandria, LA
Order Number: DWC-2748
Date of Order: 9/12/2013
Order Final In: September
Action Taken: Fined $9,000
Violation: Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange
Tarrant County College District of Fort Worth
Order Number: DWC-2747
Date of Order: 9/12/2013
Order Final In: September
Action Taken: Fined $15,000
Violation: Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange
Vigilant Insurance Company of Warren, NJ
Order Number: DWC-2768
Date of Order: 9/18/2013
Order Final In: September
Action Taken: Fined $6,500
Violation: Failed to submit accurate medical bill data to TDI-DWC
Source: TDI-DWC