Texas Work Comp Division Assesses Nearly $78K in Penalties

In disciplinary actions taken by Texas Commissioner of Workers’ Compensation Albert Betts in October and November 2007, the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) assessed administrative penalties totaling $77,800 for violations of the Texas Workers’ Compensation Act.

Commissioner’s orders are subject to appeal to state district court within 30 days after being issued.

Texas DWC disciplinary orders for October and November 2007:

Howard Douglas, M.D. of Denton
Order No.: DWC-07-0111
Date of Order: Oct. 9, 2007
Action Taken: Fined $2,000
Violation(s): Failure to timely file the report of medical examination (two instances).

Lumbermen’s Underwriting Alliance of Boca Raton, FL
Order No.: DWC -07-0018
Date of Order: Oct. 30, 2007
Action Taken: Fined $25,000
Violation(s): Failure to timely comply with a Medical Dispute Resolution (two instances). Failure to timely respond to a Commissioner’s Order to refund an independent review organization fee (one instance).

American Home Assurance Company of New York, NY
Order No.: DWC-07-0121
Date of Order: Nov. 2, 2007
Action Taken: Fined $3,000
Violation (s): Failure to include the correct exception code or provide sufficient explanation at the time the carrier made payment or denied payment on a medical bill.

Great American Alliance Insurance Company of Princeton, NJ
Order No.: DWC-07-0132
Date of Order: Nov. 30, 2007
Action Taken: Fined $8,000
Violation(s): Failure to pay reasonable and necessary medical costs for medical services which were preauthorized by the insurance carrier.

Hyatt Corporation of Chicago, IL
Order No.: DWC -07-0131
Date of Order: Nov. 30, 2007
Action Taken: Fined $2,000
Violation(s): Failure to include the correct exception code or provide sufficient explanation at the time the carrier made payment or denied payment on a medical bill.

Indiana Lumbermens Mutual Insurance Company of Indianapolis, IN
Order No.: DWC-07-0135
Date of Order: Nov. 30, 2007
Action Taken: Fined $5,000
Violation(s): Failure to timely take action on a health care provider’s claim and a medical bill.

Insurance Company of the State of Pennsylvania of Harrisburg, PA
Order No.: DWC-07-0123
Date of Order: Nov. 2, 2007
Action Taken: Fined $6,000
Violation(s): Failure to timely take action on a health care provider’s claim and a medical bill (two instances).

Liberty Insurance Corporation of Boston, MA
Order No.: DWC-07-0133
Date of Order: Nov. 30, 2007
Action Taken: Fined $2,000
Violation(s): Failure to include the correct exception code or provide sufficient explanation at the time the carrier made payment or denied payment on a medical bill.

Liberty Insurance Corporation of Boston, MA
Order No.: DWC-07-0137
Date of Order: Nov. 30, 2007
Action Taken: Fined $2,800
Violation(s): Failure to give sufficient explanation for a reduction or denial of a medical bill.

Liberty Insurance Corporation of Boston, MA
Order No.: DWC-07-0138
Date of Order: Nov. 30, 2007
Action Taken: Fined $5,000
Violation(s): Failure to give sufficient explanation for a reduction or denial of a medical bill.

Liberty Mutual Fire Insurance Company of Boston, MA
Order No.: DWC-07-0136
Date of Order: Nov. 30, 2007
Action Taken: Fined $2,000
Violation(s): Failure to timely take action on a correctly completed request for reconsideration of a medical bill.

Longview Regional Medical Center of Longview
Order No.: DWC-07-0122
Date of Order: Nov. 2, 2007
Action Taken: Fined $5,000
Violation(s): Violated Texas Labor Code § 413.042 by pursuing a private claim against a workers’ compensation claimant.

John C. McConnell, M.D. of Greenville
Order No.: DWC-07-0128
Date of Order: Nov. 26, 2007
Action Taken: Fined $2,000
Violation(s): Untimely or inappropriately filing of Work Status Reports with the insurance carrier discovered in a Division audit.

Westport Insurance Corporation of Overland Park, KS
Order No.: DWC-07-0134
Date of Order: Nov.30, 2007
Action Taken: Fined $8,000
Violation(s): Failure to conduct on-site accident prevention visits, or other appropriate services, at least every 12 months for each policyholder (two instances).

Source: Texas Department of Insurance