This file is historical in nature. Links and contact information may be outdated and no longer valid.
March 4, 2009
DWC Announces Enforcement Actions for December 2008 and January 2009
AUSTIN, Tx - Commissioner of Workers’ Compensation Rod Bordelon recently announced final disciplinary actions taken by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) in December 2008 and January 2009. The final actions include orders assessing administrative penalties totaling $169,800 for violations of the Texas Labor Code and rules promulgated by the Commissioner of Workers’ Compensation. Commissioner’s orders are subject to appeal to state district court within 30 days after being issued.
Copies of Commissioner of Workers' Compensation orders may be obtained by calling Victoria Ortega, TDI-DWC Legal Services, at 512-804-4715 or via e-mail to Victoria.Ortega@tdi.state.tx.us.
DIVISION OF WORKERS' COMPENSATION
FINAL DISCIPLINARY ORDERS DECEMBER 2008 THROUGH JANUARY 2009 (alphabetical order)
Ace American Insurance Company of Philadelphia,PA
Order No.: DWC-08-0094
Date of Order:December 19, 2008
Action Taken: Fined $37,500
Violation(s): Failure to use a doctor licensed in the State ofTexas to review health care services requested by a health care provider for medical necessity (10 instances).
ACIG Insurance Company ofDallas
Order No.: DWC-09-0010
Date of Order:January 30, 2009
Action Taken: Fined $2,000
Violation(s): Failure to take final action on a medical bill no later than the 45th day following receipt.
American Casualty Company of Reading Pennsylvania ofChicago,IL
Order No.: DWC-09-0001
Date of Order:January 7, 2009
Action Taken: Fined $4,000
Violation(s): Failure to use a doctor licensed in the State ofTexas to review health care services requested by a health care provider for medical necessity.
American Home Assurance Company ofNew York City,NY
Order No.: DWC-09-0005
Date of Order:January 8, 2009
Action Taken: Fined $22,500
Violation(s): Failure to use a doctor licensed in the State ofTexas to review health care services requested by a health care provider for medical necessity (six instances).
Fidelity and Guaranty Insurance Company ofSaint Paul,MN
Order No.: DWC-09-0007
Date of Order:January 8, 2009
Action Taken: Fined $9,000
Violation(s): Late payment for preauthorized services (five instances); improper denial of partial payment for preauthorized services.
Indemnity Insurance Company of North America ofPhiladelphia,PA
Order No.: DWC-08-0095
Date of Order:December 19, 2008
Action Taken: Fined $7,500
Violation(s): Failure to use a doctor licensed in the State ofTexas to review health care services requested by a health care provider for medical necessity (two instances).
The Insurance Company of the State of Pennsylvania ofHarrisburg,PA
Order No.: DWC-09-0004
Date of Order:January 8, 2009
Action Taken: Fined $7,500
Violation(s): Failure to use a doctor licensed in the State ofTexas to review health care services requested by a health care provider for medical necessity (two instances).
Charles Murphy, M.D. ofPlano
Order No.: DWC-09-0003
Date of Order:January 8, 2009
Action Taken: Fined $45,000
Violation(s): Failure to file the Report of Medical Evaluation in a timely manner (106 instances); failure to file the Report of Medical Evaluation before the seven-day deadline expired (106 instances); and failure to meet the compliance standard of 95 percent.
New Hampshire Insurance Company ofHarrisburg,PA
Order No.: DWC-09-0006
Date of Order:January 8, 2009
Action Taken: Fined $7,500
Violation(s): Failure to use a doctor licensed in the State ofTexas to review health care services requested by a health care provider for medical necessity (two instances).
Eric Roberson, M.D. of Webster
Order No.: DWC-09-0009
Date of Order:January 30, 2009
Action Taken: Fined $12,300
Violation(s): Failure to file the Report of Medical Evaluation in a timely manner (105 instances); failure to file the Report of Medical Evaluation with the insurance carrier by facsimile or electronic transmission (105 instances); failure to file the Report of Medical Evaluation before the seven-day deadline (105 instances); and failure to meet the compliance standard of 95 percent.
Zurich American Insurance Company ofSchaumburg,IL
Order No.: DWC-09-0002
Date of Order:January 7, 2009
Action Taken: Fined $15,000
Violation(s): Failure to use a doctor licensed in the State ofTexas to review health care services requested by a health care provider for medical necessity (four instances).
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Last updated: 02/14/2012
This file is historical in nature. Links and contact information may be outdated and no longer valid.
