Austin, TX – Commissioner of Workers’ Compensation, Ryan Brannan, recently announced final disciplinary actions taken by the Division of Workers’ Compensation (DWC).
The final actions include administrative penalties ordered against insurance carriers and health care providers in the workers’ compensation system. Beginning January 1, 2015, through April 30, 2015, the Commissioner of Workers’ Compensation has ordered administrative penalties totaling $549,500 for system participants. The penalties include $487,800 in fines ordered for insurance carriers, $40,700 in fines ordered for health care providers, and $21,000 in fines ordered for other entities.
Violations of the Texas Labor Code by insurance carriers cited in recent orders include failure to accurately pay benefits ordered to an injured employee, failure to accurately and timely notify DWC of termination of benefits, and failure to timely take action on a medical bill. Violations cited in orders naming health care providers include improper billing of medical services to an injured employee; issuing improper, unreasonable, or medically unnecessary treatment or medical services to an injured employee; and failure to timely file and/or accurately complete DWC forms, reports, or records. Violations cited in orders naming other entities include failure to timely respond to DWC when ordered to produce requested documents.
Summaries of the orders:
Commerce and Industry Insurance Company of New York, NY
Order Number: DWC-3891
Date of Order: 4/2/2015
Action Taken: Fined $34,000
Violation: Failed to accurately pay income and death benefits; Failed to timely submit claims data to TDI-DWC
Contnental Casualty Company of Chicago, IL
Order Number: DWC-3907
Date of Order: 4/14/2015
Action Taken: Fined $3,000
Violation: Failed to timely pay or act on injured employees’ request for reimbursement of pharmaceutical expenses
Corley, Ronald G., M.D. of Lufkin
Order Number: DWC-3913
Date of Order: 4/16/2015
Action Taken: Permanently removed from designated doctor list and MMI/IR certification and may not reapply for designated doctor list
Violation: Failed to comply with requirements for designated doctor examinations
Cummings, Eliseo D.C. of Conroe
Order Number: DWC-3893
Date of Order: 4/2/2015
Action Taken: Fined $2,500
Violation: Failed to comply with requirements for the location of designated doctor examinations
Five Points Health of El Paso
Order Number: DWC-3911
Date of Order: 4/16/2015
Action Taken: Fined $1,000
Violation: Improperly billed an injured employee for workers’ compensation medical services provided
Liberty Insurance Corporation of Boston, MA
Order Number: DWC-3908
Date of Order: 4/14/2015
Action Taken: Fined $32,000
Violation: Failed to accurately pay income benefits to injured employees; Failed to accurately pay death benefits; Failed to provide accurate claim data to TDI-DWC; Failed to timely pay or act on injured employees’ request for reimbursement
Mussaji, Murtaza, D.O. of Houston
Order Number: DWC-3899
Date of Order: 4/7/2015
Action Taken: Must not apply for admission to designated doctor list for two years.
Violation: Failed to comply with requirements for documenting impairment rating and designated doctor examinations
New Hampshire Insurance Company of New York City, NY
Order Number: DWC-3892
Date of Order: 4/2/2015
Action Taken: Fined $19,500
Violation: Failed to timely pay income benefits to injured employee; Failed to timely act on a properly completed medical bill; Failed to properly complete a request for designated doctor examination; Failed to timely comply with TDI-DWC order
Old Republic General Insurance Corporation of Chicago, IL
Order Number: DWC-3939
Date of Order: 4/30/2015
Action Taken: Fined $2,000
Violation: Failed to list all injuries determined to be compensable by TDI-DWC when requesting designated doctor examination
QAVU PLLC of Kingwood
Order Number: DWC-3934
Date of Order: 4/28/2015
Action Taken: Fined $2,000
Violation: Improperly billed an injured employee for workers’ compensation medical services provided
Rodgers, Jerry M.D. of Point
Order Number: DWC-3932
Date of Order: 4/24/2015
Action Taken: Must not apply for admission to the designated doctor list for three years
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports and records
Safety National Casualty Corporation of St. Louis, MO
Order Number: DWC-3909
Date of Order: 4/14/2015
Action Taken: Fined $5,000
Violation: Failed to timely pay accrued income benefits to an injured employee after receipt of designated doctor’s report; Failed to timely pay income benefits to an injured employee
Shaw-Rice, Judi Ann M.D. of Houston, TX
Order Number: DWC-3890
Date of Order: 4/2/2015
Action Taken: Fined $4,000; Must not re-apply for designated doctor certification; Must surrender maximum medical improvement/impairment rating credentials
Violation: Failed to inform TDI-DWC of disciplinary actions taken by Texas Medical Board; Failed to timely file designated doctors’ reports following examination of injured employees
Soriano, Ramon M.D. of Laredo
Order Number: DWC-3938
Date of Order: 4/30/2015
Action Taken: Fined $2,000; Must complete continuing medical education, medical record keeping and documentation training and ethics training;
Violation: Diagnosis, treatment and evaluations of injured employee substantially different from those found to be fair and reasonable; Provided improper, unreasonable or medically unnecessary treatment or services; Failed to approve or recommend all health care reasonably required for injured employee
Southeast Service Corporation of Chesterbrook, PA
Order Number: DWC-3918
Date of Order: 4/29/2015
Action Taken: Fined $1,000
Violation: Failed to respond to a request for information from TDI-DWC
Taxis, John O., D.O. of Sugar Land, TX
Order Number: DWC-3912
Date of Order: 4/16/2015
Action Taken: Must not re-apply for designated doctor certification; Must surrender maximum medical improvement/impairment rating credentials
Violation: Failed to comply with requirements for documenting impairment rating and designated doctor examinations
Source: TDI-DWC