Texas Workers’ Comp Division Announces August Enforcement Actions

Texas Commissioner of Workers’ Compensation Rod Bordelon recently announced final disciplinary actions taken in August by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC). Commissioner’s orders are subject to appeal to state district court within 30 days after being issued.

Final Disciplinary Orders For August 2010 (alphabetical order)

Advantage Workers Compensation Insurance Company of Salt Lake City, UT
Order Number: DWC10-0065
Date of Order: 8/18/2010
Order Final In: August
Action Taken: Fined $6,000
Violation: Failed to comply with order or decision of the Commissioner

Argonaut Southwest Insurance Company of San Antonio
Order Number: DWC-10-0054
Date of Order: 8/3/2010
Order Final In: August
Action Taken: Fined $3,000
Violation: Failed to timely pay or dispute benefits

Fedex Freight of Memphis, TN
Order Number: DWC-10-0060
Date of Order: 8/12/2010
Order Final In: August
Action Taken: Fined $14,000
Violation: Failed to timely pay or dispute benefits; Failed to accurately submit medical bill and payment data to the Division within 30 days after insurance carrier makes payment, denies payment or receives refund of overpayment; failed to timely pay an order for attorneys fees

Insurance Company of the State of Pennsylvania of Harrisburg, PA
Order Number: DWC10-0067
Date of Order: 8/25/2010
Order Final In: August
Action Taken: Fined $175,000
Violation: Failure to comply with workers’ compensation system administrative rules and procedures (43 instances)

King County Emergency Medical Services of Guthrie
Order Number: DWC10-0058
Date of Order: 8/3/2010
Order Final In: August
Action Taken: Fined $1,000
Violation: Submitted bill for payment to injured employee; Pursued private claim against injured employee

New Hampshire Insurance Company of New York, NY
Order Number: DWC-10-0068
Date of Order: 8/25/2010
Order Final In: August
Action Taken: Fined $175,000
Violation: Failure to comply with workers’ compensation system administrative rules and procedures

Northern Insurance Company of New York of Schaumburg, IL
Order Number: DWC10-0055
Date of Order: 8/3/2010
Order Final In: August
Action Taken: Fined $6,000
Violation: Failed to timely comply with a medical fee dispute decision and order

Roos, Linda J., M.D. of Houston
Order Number: DWC10-0066
Date of Order: 8/18/2010
Order Final In: August
Action Taken: Cease and desist from providing or rendering health care services in workers’ compensation system
Violation: Engaged in conduct relating to delivery, evaluation, or remuneration of health that Division finds is unreasonable and does not meet standards of health care

Texas Cotton Ginners Trust of Austin
Order Number: DWC-10-0064
Date of Order: 8/18/2010
Order Final In: August
Action Taken: Fined $5,500
Violation: Failed to timely pay or dispute benefits (three instances); Failed to accurately submit claim data to the Division (16 instances)

The Gray Insurance Company of Metairie, LA
Order Number: DWC-10-0063
Date of Order: 8/18/2010
Order Final In: August
Action Taken: Fined $25,000
Violation: Failed to timely pay or dispute benefits; Failed to timely pay or deny payment of medical bills; Failed to timely and/or accurately submit medical bill and claim data to Division electronically; Failed to timely file accident prevention services annual report

Van Hal, Marvin M.D. of Southlake
Order Number: DWC10-0056
Date of Order: 8/3/2010
Order Final In: August
Action Taken: Fined $1,000
Violation: Filed to timely file the DWC Form-69 with the insurance carrier (25 instances); Failed to file the DWC Form-69 to insurance carrier via facsimile or electronic transmission (26 instances)

Wausau Business Insurance Company of Boston, MA
Order Number: DWC10-0057
Date of Order: 8/3/2010
Order Final In: August
Action Taken: Fined $5,000
Violation: Failed to timely pay or dispute benefits

Source: Texas Department of Insurance, Division of Workers’ Compensation