Texas Workers’ Comp May Enforcements Bring More than $70K in Fines

Final disciplinary actions taken by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) for May 2011 resulted in more than $70,000 in fines.

Division of Workers’ Compensation final disciplinary orders for May 2011 include:

American Zurich Insurance Company of Schaumburg, Ill.
Order Number: DWC11-0057
Date of Order: 5/6/2011
Order Final In: May
Action Taken: Fined $9,000
Violation: Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to accurately submit medical bill and payment data ; Failed to comply with order or decision of Commissioner or TDI-DWC; Failed to timely reimburse injured employee for travel expenses

Gibbons, Raymond Robert M.D. of Dallas
Order Number: DWC11-0055
Date of Order: 5/6/2011
Order Final In: May
Action Taken: Must limit injuries, illnesses and body areas evaluated; Must attend compliance training for doctors and medical office staff
Violation: Failed to assign Impairment Ratings in accordance with American Medical Association Guides

Hanover Insurance Company of Worcester, Mass.
Order Number: DWC11-0053
Date of Order: 5/6/2011
Order Final In: May
Action Taken: Fined $15,000
Violation: Failed to comply with order or decision of Commissioner or TDI-DWC; Failed to accurately submit medical bill and payment data

Hartford Casualty Insurance Corporation of Hartford, Conn.
Order Number: DWC11-0060
Date of Order: 5/16/2011
Order Final In: May
Action Taken: Fined $5,500
Violation: Failed to timely pay income benefits to injured employee; Failed to timely pay attorney fees

Indemnity Insurance Company of North America of Philadelphia, Pa.
Order Number: DWC11-0054
Date of Order: 5/6/2011
Order Final In: May
Action Taken: Fined $15,500
Violation: Failed to comply with order or decision of Commissioner or TDI-DWC; Failed to timely pay income benefits to injured employee

New Hampshire Insurance Company of New York, N.Y.
Order Number: DWC11-0056
Date of Order: 5/6/2011
Order Final In: May
Action Taken: Fined $5,000
Violation: Failed to timely pay income benefits to injured employee

Spine & Orthopaedic Institute of Boston, Mass.
Order Number: DWC11-0059
Date of Order: 5/6/2011
Order Final In: May
Action Taken: Fined $1,500
Violation: Failed to properly respond to insurance carriers request for refund

Texas Hospital Insurance Exchange of Austin
Order Number: DWC11-0058
Date of Order: 5/6/2011
Order Final In: May
Action Taken: Fined $5,000
Violation: Failed to timely submit medical bill and payment data to TDI-DWC

XL Insurance America Inc. of Exton, Pa.
Order Number: DWC11-0061
Date of Order: 5/27/2011
Order Final In: May
Action Taken: Fined $7,000
Violation: Failed to accurately submit medical bill and payment data

Zurich American Insurance Company of Schaumburg, Ill.
Order Number: DWC11-0052
Date of Order: 5/6/2011
Order Final In: May
Action Taken: Fined $10,000
Violation: Failed to timely pay medical bill or to pay medical bill according to Division Medical Fee Guidelines; Failed to sufficiently explain reasons for the reduction or denial of payment for health care services; Failed to pay for preauthorized medical services

TDI-DWC