Texas Workers’ Comp January Enforcements Include Fines Up to $68K

Final disciplinary actions taken by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) for January 2011 include individual fines up to $68,000. The final actions include orders related to violations of the Texas Labor Code and rules promulgated by Workers’ Compensation Commissioner Rod Bordelon.

TDI-DWC Final Enforcement Actions for January 2011:

Ace American Insurance Company of Philadelphia, Pa.
Order Number: DWC-110011
Date of Order: 1/26/2011
Order Final In: January
Action Taken: Fined $48,000
Violation: Failed to comply with TDI-DWC or Commissioner Order; Failed to timely pay income benefits to injured employee; Failed to timely act on request for reconsideration of a medical bill; Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange

American Casualty Company of Reading, Pennsylvania of Chicago, Ill.
Order Number: DWC-110005
Date of Order: 1/10/2011
Order Final In: January
Action Taken: Fined $25,000
Violation: Failed to timely pay income benefits to injured employee; Failed to comply with TDI-DWC or Commissioner Order; Failed to pay medical bills according to TDI-DWC Medical Fee Guidelines; Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange; Failed to timely act on request for reconsideration of a medical bill; Failed to pay for preauthorized medical services

Chen, Dean M.D. of Austin
Order Number: DWC-110004
Date of Order: 1/10/2011
Order Final In: January
Action Taken: Fined $2,000; Must attend compliance training for doctors and medical office staff
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports or records

Christus Santa Rosa Hospital of San Antonio
Order Number: DWC-110001
Date of Order: 1/10/2011
Order Final In: January
Action Taken: Fined $6,000
Violation: Improperly billed an injured employee for workers’ compensation medical services provided

CorVel Healthcare Corporation of Addison
Order Number: DWC-110007
Date of Order: 1/10/2011
Order Final In: January
Action Taken: Fined $7,000
Violation: Failed to provide TDI-DWC with list of insurance carriers with whom the network contracted and/or timely report changes to list to TDI-DWC

Indemnity Insurance Company of North America of Philadelphia, Pa.
Order Number: DWC-110016
Date of Order: 1/28/2011
Order Final In: January
Action Taken: Fined $68,000
Violation: Failed to comply with TDI-DWC or Commissioner Order; Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to sufficiently explain the reasons for the reduction or denial of payment for health care services to the injured employee; Failed to timely pay income benefits to injured employee; Failed to pay for preauthorized medical services

Jolivet, David Anthony M.D. of Houston

Order Number: DWC-110012
Date of Order: 1/26/2011
Order Final In: January
Action Taken: Fined $4,000; Must attend compliance training for doctors and medical office staff
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports or records

Knoll, Victoria D., M.D. of Plano
Order Number: DWC-110002
Date of Order: 1/10/2011
Order Final In: January
Action Taken: Fined $1,000;
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports or records

Lee, Walter M.D. of Houston
Order Number: DWC-110015
Date of Order: 1/28/2011
Order Final In: January
Action Taken: Fined $8,000; Must attend compliance training for doctors and medical office staff
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports or records

Lumbermen’s Underwriting Alliance of Boca Raton, Fla.
Order Number: DWC-110017
Date of Order: 1/28/2011
Order Final In: January
Action Taken: Fined $4,500
Violation: Failed to timely pay income benefits to injured employee; Failed to timely comply with an order to pay income benefits

Metropolitan Methodist Hospital of Cincinnati, Ohio
Order Number: DWC-110014
Date of Order: 1/26/2011
Order Final In: January
Action Taken: Fined $10,000
Violation: Improperly billed an injured employee for workers’ compensation medical services provided

Puig, Louis Frank III, M.D. of Pasadena
Order Number: DWC-110013
Date of Order: 1/26/2011
Order Final In: January
Action Taken: Fined $2,000; Must attend compliance training for doctors and medical office staff
Violation: Failed to timely file and/or accurately complete TDI-DWC forms, reports or records

Quest Diagnostics Inc. of Collegeville, Pa.
Order Number: DWC-110010
Date of Order: 1/26/2011
Order Final In: January
Action Taken: Fined $5,000
Violation: Improperly billed an injured employee for workers’ compensation medical services provided

XL Specialty Insurance Company of Exton, Pa.
Order Number: DWC-110003
Date of Order: 1/10/2011
Order Final In: January
Action Taken: Fined $25,000
Violation: Failed to timely pay income benefits to injured employee; Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange; Failed to timely pay attorney fees

Source: TDI-DWC