Workers' compensation disciplinary orders after 2019
Disciplinary orders before 2019: 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018
| Order number | Date issued | Subject | Action taken | Violation |
|---|---|---|---|---|
| 4236 | 12/28/2015 | Starr Indemnity & Liability Company | Fined $500 | Failed to timely pay income benefits to injured employees |
| 4235 | 12/28/2015 | Commerce and Industry Insurance Company | Fined $15,000 | Failed to timely pay income benefits to injured employees |
| 4232 | 12/28/2015 | Indemnity Insurance Company of North America | Fined $4,000 | Failed to timely pay income benefits to injured employee; failed to timely pay attorney's fees |
| 4234 | 12/28/2015 | New Hampshire Insurance Company | Fined $4,000 | Failed to submit complete documentation of employee injuries determined to by compensable to TDI-DWC |
| 4231 | 12/28/2015 | Praetorian Insurance Company | Fined $20,000 | Failed to timely process medical bills; failed to accurately submit medical electronic data interchange records to TDI-DWC |
| 4233 | 12/28/2015 | White, Stephen C., M.D. | Must complete medical record documentation training | Failed to document consultation with injured employee including employee's refusal of health care within appropriate time frame |
| 4218 | 12/11/2015 | Halaby, Gerald A., M.D. | Fined $500 | Failed to comply with commissioner's order to complete continuing education requirement. |
| 4216 | 12/8/2015 | Soberanis, Jose D.C. | Fined $10,000; must not apply to designated doctor list or for maximum medical improvement/impairment rating certification for 10 years | Failed to timely file and/or accurately complete TDI-DWC forms, reports or records |
| 4211 | 12/4/2015 | Buchanan, Lynn, D.O. | Fined $4,000 | Failed to comply with order of TDI-DWC |
| 4212 | 12/4/2015 | Dallas I.S.D. | Fined $2,000 | Failed to timely pay income benefits to injured employee |
| 4206 | 12/2/2015 | Ace American Insurance Company | Fined $15,000 | Failed to timely pay income benefits to injured employees; failed to timely comply with a TDI-DWC order |
| 4205 | 12/2/2015 | Kjeldgaard, Larry Mitchell D.O. | Medical practice in Texas workers' compensation system subject to review by TDI-DWC under a limited monitoring plan | Improperly administered treatments or services |
| 4207 | 12/2/2015 | Northeast Baptist Hospital | Fined $2,000 | Improperly billed injured employee for workers' compensation medical services provided. |
| 4208 | 12/2/2015 | Starr Indemnity and Liability Company | Fined $5,500 | Failed to timely pay accrued and unpaid income benefits to injured employee as ordered by TDI-DWC |
| 4204 | 12/1/2015 | Liberty Mutual Fire Insurance Company | Fined $35,000 | Failed to timely report termination of death benefits to TDI-DWC; failed to accurately pay death benefits to injured employee's beneficiaries |
| 4192 | 11/18/2015 | Worrell, John Mays, Jr., M.D. | Must complete continuing medical education | Administered improper, unreasonable or medically unnecessary treatment |
| 4185 | 11/17/2015 | Bradley, David D.C. | Fined $1,000 | Failed to timely file and/or accurately complete TDI-DWC forms, reports or records; failed to sufficiently respond to a letter of clarification ordered by division |
| 4189 | 11/17/2015 | Old Republic Insurance Company | Fined $4,000 | Failed to timely pay income benefits to injured employees |
| 4188 | 11/17/2015 | Rapid Tox Screen, L.L.C. | Fined $4,000 | Failed to respond to request for refund from insurance carrier; failed to comply with division order |
| 4186 | 11/17/2015 | T.H.E. Insurance Company | Fined $11,500 | Failed to process claims in reasonable and prudent manner; failed to timely contact and offer a survey to its policyholder after learning of a work-related fatality |
| 4187 | 11/17/2015 | T.H.E. Insurance Company | Fined $3,000 | Failed to timely comply with decision of commissioner |
| 4184 | 11/17/2015 | TASB Risk Management, Inc. | Fined $25,000 | Failed to timely pay income benefits to injured employees |
| 4164 | 10/28/2015 | City of Houston | Fined $2,000 | Failed to timely pay attorney fees |
| 4165 | 10/28/2015 | Markel Insurance Company | Fined $10,000 | Failed to timely act on a properly completed medical bill; failed to submit accurate medical EDI records to the Division |
| 4167 | 10/28/2015 | Obasi, Patrick Chidi, M.D. | Fined $2,000; must not re-apply for designated doctor or maximum medical improvement/impairment rating certification for two years. | Deficiencies in examinations of injured employees as part of a medical quality review |
| 4170 | 10/28/2015 | Shade, Ronnie D., M.D. | Fined $500 | Failed to comply with Division order |
| 4166 | 10/28/2015 | Technology Insurance Company, Inc. | Fined $1,500 | Failed to comply with order to timely pay attorney's fees |
| 4169 | 10/28/2015 | Twin City Fire Insurance Company | Fined $5,500 | Failed to timely pay income benefits to injured employee; failed to pay income benefits during the pendency of a dispute |
| 4160 | 10/21/2015 | Weigel, Sofia Maristany, M.D. | Fined $25,000 | Failed to timely file and/or accurately complete TDI-DWC forms, reports or records |
| 4146 | 10/9/2015 | ACS Primary Care Physicians Southwest PA | Fined $3,000 | Improperly billed an injured employee for workers' compensation medical services provided. |
| 4147 | 10/9/2015 | American Guarantee and Liability Insurance Company | Fined $6,000 | Failed to accurately pay lifetime income benefits to injured employees on two claims |
| 4145 | 10/9/2015 | Hood, James Furniss M.D. | Must complete designated doctor training | Failed to properly determine and report maximum medical improvement certification date and to appropriately report and accurately assign a whole body impairment rating for injured employee |
| 4148 | 10/9/2015 | National Interstate Insurance Company | Fined $15,000 | Failed to accurately pay death benefits; failed to provide accurate claim data to Division |
| 4144 | 10/9/2015 | Pulido, Christopher, D.C. | Fined $2,000 | Failed to obtain injured employee's agreement before rescheduling a designated doctor examination appointment |
| 4141 | 10/7/2015 | Coolbaugh, Robert J., D.C. | (SOAH DOCKET NO. 454-14-3930.C1) Fined $10,000 | Failed to timely comply with division orders |
| 4137 | 10/5/2015 | New Hampshire Insurance Company | Fined $8,500 | Failed to comply with order to timely pay income benefits to injured employee; failed to timely pay attorney's fees; failed to timely act on a properly completed medical bill |
| 4134 | 10/2/2015 | New Hampshire Insurance Company | Fined $7,000 | Failed to timely pay income benefits to injured employee |
| 4135 | 10/2/2015 | Setliff, Michael, D.C. | Fined $500; Must complete designated doctor training | Failed to adequately complete designated doctor narrative report |
| 4132 | 9/25/2015 | Arch Insurance Company | Fined $1,200 | Failed to comply with an order to pay attorney's fees; failed to timely pay attorney's fees |
| 4122 | 9/22/2015 | American Zurich Insurance Company | Fined $7,000 | Failed to pay accurate death benefits to legal beneficiaries; failed to timely contact and offer a survey to its policyholder after a work-related fatality |
| 4121 | 9/22/2015 | Capitol Emergency Associates, P.A. | Fined $4,500 | Improperly billed an injured employee for workers' compensation medical services provided |
| 4123 | 9/22/2015 | Safety National Casualty Corporation | Fined $1,000 | Failed to comply with an order to pay attorney's fees; failed timely pay attorney's fees |
| 4116 | 9/18/2015 | Armstrong, Jarrett H., D.C. | Fined $500 | Failed to timely notify TDI-DWC that he had not received medical records; failed to reschedule designated doctor examination |
| 4114 | 9/16/2015 | City of El Paso | Fined $21,000 | Failed to pay accurate death benefits |
| 4113 | 9/16/2015 | Hernandez, Arthur S., M.D. | Fined $5,000; will not provide health care to injured employees in the Texas workers' compensation system or receive any renumeration from the Texas workers’ compensation system | Ordered treatment and/or diagnostic testing of an injured employee without documenting justification for the testing |
| 4115 | 9/16/2015 | Travelers Indemnity Company | Fined $3,000 | Failed to timely act on a properly completed medical bill |
| 4111 | 9/15/2015 | Northern Insurance Company of New York | Fined $2,000 | Failed to pay accurate lifetime income benefits to an injured employee |
| 4112 | 9/15/2015 | Zurich American Insurance Company | Fined $15,200 | Failed to pay accurate lifetime income benefits to injured employees; failed to pay accurate death benefits to injured employees; failed to timely comply with contested case hearing order |
| 4106 | 9/10/2015 | Miller, Hank K., D.C. | Fined $5,000; must not re-apply for designated doctor certification or maximum medical improvement/impairment rating credentials. | Improperly certified maximum medical improvement of an injured employee without performing complete medical examination; failed to file work status report for an injured employee; ordered unnecessary testing and failed to explain rationale for testing during designated doctor examination |
| 4105 | 9/10/2015 | Travelers Indemnity Company of Connecticut | Fined $60,000 | Failed to pay accurate death benefits to legal beneficiaries; failed to timely report termination of death benefits to TDI-DWC |
| 4099 | 9/1/2015 | Loper, David W., D.C. | Fined $1,000. | Failed to timely file and/or accurately complete TDI-DWC forms, reports or records |
| 4086 | 8/19/2015 | Tays, Cynthia Lysne D.C. | Fined $2,000; must complete continuing medical education hours in addition to those required for chiropractic licensure renewal | Submitted medical bill for an examination of an injured employee that was not performed |
| 4082 | 8/13/2015 | Ace American Insurance Company | Fined $9,900 | Failed to timely pay income benefits to injured employees |
| 4077 | 8/11/2015 | The Travelers Indemnity Company | Fined $7,500 | Failed to timely pay accrued income benefits to injured employees; failed to timely pay benefits to injured employee |
| 4075 | 8/7/2015 | Franz, Jerry L., M.D. | Fined $2,000 | Failed to meet standard of care for chronic pain management for five injured employees |
| 4073 | 8/4/2015 | Ekeruo, Ijeoma Ananaba M.D. | Must not re-apply for designated doctor certification or maximum medical improvement/impairment rating certification for five years | Failed to timely file TDI-DWC report following examination of injured employee |
| 4074 | 8/4/2015 | Sentry Insurance, A Mutual Company | Fined $20,000 | Failed to pay accurate death benefits to legal beneficiaries;failed to provide accurate claims data to TDI-DWC; failed to timely notify TDI-DWC of annual increases in lifetime income benefits |
| 4064 | 7/29/2015 | Burke, Terry Lee D.C. | Fined $1,000 | Failed to obtain agreement from injured employee before rescheduling a designated doctor examination |
| 4065 | 7/29/2015 | Carter, Stephen A., M.D. | Fined $500; must complete designated doctor training | Improperly certified maximum medical improvement of an injured employee while failing to complete medical examination; failed to explain rationale for testing in designated doctor examinations |
| 4058 | 7/27/2015 | Case, Charles Frank D.C. | Will not re-apply for designated doctor certification or maximum medical improvement/impairment rating certification for five years | Failed to complete a fair and reasonable evaluation of an injured employee ; made unnecessary referrals; failed to timely file report of medical evaluation and narrative report |
| 4059 | 7/27/2015 | CST Services, L.L.C. | Fined $10,000 | Failed to timely submit non-subscriber notice of non-coverage; failed to timely file report of non-covered employee's occupational injury or disease |
| 4056 | 7/27/2015 | New Hampshire Insurance Company | Fined $34,000 | Failed to provide a sufficient and reasonable explanation for reduction or denial of payment of medical bills; failed to timely pay income benefits in accordance with designated doctor reports; failed to timely pay attorney's fees; failed to timely act on a completed medical bill |
| 4057 | 7/27/2015 | PharMerica | Fined $2,000 | Improperly billed an injured employee for workers' compensation services |
| 4060 | 7/27/2015 | Wausau Underwriters Insurance Company | Fined $8,000 | Failed to timely pay income benefits to injured employee; failed to accurately notify TDI-DWC and injured employee of actions taken on a claim |
| 4050 | 7/17/2015 | Batlle, Francisco M.D. | Must complete additional continuing medical education | Failed to complete a fair and reasonable evaluation of an injured employee |
| 4051 | 7/17/2015 | Lee, Randi D.C. | Fined $2,000 | Failed to timely contact injured employee to cancel designated doctor examination; failed to timely reschedule examination; failed to notify TDI-DWC that examination could not be timely rescheduled |
| 4052 | 7/17/2015 | Physicians and Allied Health | Default Order. Fined $8,000 | Improperly billed an injured employee for workers' compensation services |
| 4042 | 7/7/2015 | Washington, Ronald J., M.D. | Default Order. Fined $7,500; must complete medical training in pharmacology and prescribing | Administered improper, unreasonable or medically unnecessary treatment by continuing to prescribe medications without documenting justification and risk factors |
| 4033 | 7/2/2015 | American Home Assurance Company | Fined $90,000; audit to be performed by September 1, 2015 | Failed to pay accurate lifetime income benefits to injured employees; failed to pay accurate death benefits to legal beneficiaries; failed to provide accurate claim data to TDI-DWC; failed to timely notify TDI-DWC of annual lifetime income benefits increases |
| 4036 | 7/2/2015 | Arch Insurance Company | Fined $19,000 | Failed to pay accurate death benefits to legal beneficiaries; failed to provide accurate claim data to TDI-DWC; failed to timely report termination of death benefits to TDI-DWC; failed to timely act on a request for reconsideration |
| 4037 | 7/2/2015 | ESIS, Inc. | Fined $18,000; must cease and desist from performing utilization review without a certificate of registration | Conducted utilization review without a certificate of registration; failed to conduct utilization review under direction of a licensed physician; used improper personnel to make medical necessity determinations |
| 4035 | 7/2/2015 | Transportation Insurance Company | Fined $12,000 | Failed to pay accurate death benefits to legal beneficiaries; failed to provide accurate claim data to TDI-DWC; failed to timely report termination of death benefits to TDI-DWC |
| 4032 | 7/1/2015 | Valero Energy Corporation | Fined $2,500 | Failed to timely file report of non-covered employee's occupational injury or disease |
| 4024 | 6/29/2015 | Cherokee Insurance Company | Fined $2,500 | Failed to timely report payment of income benefits to injured employee to TDI-DWC; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim |
| 4025 | 6/29/2015 | Continental Casualty Company | Fined $3,000 | Failed to timely process and take final action on a completed medical bill |
| 4021 | 6/29/2015 | Dirksen, Nathaniel D.C. | Fined $1,500 | Improperly rescheduled designated doctor examination without contacting injured employee |
| 4026 | 6/29/2015 | Liberty Insurance Corporation | Fined $6,000 | Failed to timely pay income benefits to injured employee |
| 4027 | 6/29/2015 | Starbucks Corporation | Fined $1,000 | Failed to timely pay income benefits to injured employee; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim |
| 4020 | 6/29/2015 | Texas Mutual Insurance Company | Fined $8,000 | Failed to timely complete or return an incomplete medical bill; Failed to timely pay income benefits to an injured employee; Failed to timely notify injured employee of termination or suspension of income benefits; Improperly denied designated doctor medical bill |
| 4023 | 6/29/2015 | Trumball Insurance Company | Fined $8,600 | Failed to timely pay income benefits to injured employee; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim |
| 4022 | 6/29/2015 | Zurich American Insurance Company | Fined $1,800 | Failed to timely pay income benefits to injured employee in accordance with Designated Doctor report |
| 4005 | 6/5/2015 | Medical Center of Plano | Fined $2,000 | Improperly billed employer for services covered by workers' compensation insurance; Failed to timely provide medical records of an injured employee after receiving valid order to produce them |
| 4004 | 6/5/2015 | Trinh, Tuan Anh D.O. | Fined $2,500; Must attend medical record documentation course and complete four hours continuing medical education in ethics. | Failed to provide health care or meaningful diagnosis to injured employee; Failed to attempt to return injured employee to work |
| 4003 | 6/5/2015 | Zurich American Insurance Company | Fined $90,000 | Failed to accurately pay income benefits to injured employee; Failed to accurately pay death benefits to legal beneficiaries; Provided inaccurate claim data to TDI-DWC |
| 3995 | 6/3/2015 | American Zurich Insurance Company | Fined $9,000 | Failed to timely pay income benefits to injured employee |
| 3998 | 6/3/2015 | Arredondo, Eradio M.D. | Fined $1,500 | Improperly rescheduled designated doctor examination without contacting injured employee |
| 4000 | 6/3/2015 | Cordas, Stevane D.O. | Fined $2,000 | Conducted a required medical examination (RME) at an inappropriate location |
| 3997 | 6/3/2015 | Glass, Raymond Keith D.C. | Fined $2,000; Must complete four hours of continuing medical education in ethics | Submitted a medical bill for a functional capacity evaluation which was not performed and was not in accordance with Medicare policies |
| 3996 | 6/3/2015 | Stenson, Derrick James D.C. | Fined $2,000 | Submitted a medical bill for a functional capacity evaluation which was not performed and was not in accordance with Medicare billing policies |
| 3999 | 6/3/2015 | Wausau Underwriters Insurance Company | Fined $2,000 | Failed to timely act on a properly completed medical bill |
| 3983 | 5/26/2015 | Old Republic Insurance Company | Fined $5,000 | Failed to timely pay income benefits to injured employee; Failed to pay benefits based on opinion of designated doctor during pendency of dispute |
| 3982 | 5/26/2015 | Youngblood, Tonya Joyce M.D. | Fined $2,000; Must complete additional continuing education hours | Submitted a medical bill for services that were not performed and were not in accordance with applicable Medicare billing policies |
| 3976 | 5/22/2015 | Indemnity Insurance Company of North America | Fined $6,000 | Failed to timely pay income benefits to injured employee; Failed to pay benefits based on opinion of designate doctor during pendency of dispute |
| 3973 | 5/19/2015 | Dunn, Thomas P.T. | Fined $50,000; Agrees to cease participation in the Texas workers' compensation system and to not receive direct or indirect renumeration from the Texas Workers' Compensation System | Improperly billed for services provided to injured employees |
| 3972 | 5/19/2015 | Indemnity Insurance Company of North America | Fined $49,000 | Failed to accurately pay lifetime income benefits and death benefits; Failed to provide accurate and timely claims data to the division; Failed to contact its policyholder within 7 days of a work-related fatality |
| 3971 | 5/19/2015 | Key, James David, Sr., M.D. | Fined $75,000; Must not participate in treating or examining injured employees covered in the Texas workers' compensation system and/or consult with other physicians regarding injured employees in the system; Cannot receive direct or indirect remuneration from the Texas workers’ compensation system | Improperly billed for services provided to injured employees |
| 3964 | 5/15/2015 | Ace American Insurance Company | Fined $6,000; Claims adjuster must complete additional continuing education hours specified by TDI-DWC | Refused to accept medical bills submitted electronically by health care providers |
| 3966 | 5/15/2015 | Ace American Insurance Company | Fined $16,000 | Failed to pay accrued and unpaid income benefits within five days of filing its appeal; Failed to contact its policyholder within 7 days of a work-related fatality |
| 3965 | 5/15/2015 | The Travelers Indemnity Company | Fined $500 | Failed to provide sufficient explanation for reduction or denial of a medical bill |
| 3960 | 5/12/2015 | State Farm Fire and Casualty Company | Fined $5,500 | Failed to timely pay income benefits to injured employee; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim; Failed to timely report initial payment of benefits to TDI-DWC |
| 3946 | 5/6/2015 | Great Midwest Insurance Company | Fined $1,500 | Failed to timely act on a request for preauthorization of health care services for injured employee |
| 3945 | 5/6/2015 | Indemnity Insurance Company of North America | Fined $9,000 | Failed to timely pay benefits to injured employee based on opinion of designated doctor |
| 3947 | 5/6/2015 | Liberty Mutual Insurance Company | Fined $2,000 | Prospectively denied future medical benefits for injured employee |
| 3948 | 5/6/2015 | Smith, Stephen Lynn D.O. | Fined $2,000 | Used unprofessional and inappropriate language in a document directed at a workers' compensation system participant |
| 3939 | 4/30/2015 | Old Republic General Insurance Corporation | Fined $2,000 | Failed to list all injuries determined to be compensable by TDI-DWC when requesting designated doctor examination |
| 3938 | 4/30/2015 | Soriano, Ramon M.D. | Fined $2,000; Must complete continuing medical education, medical record keeping and documentation training and ethics training; | Diagnosis, treatment and evaluations of injured employee substantially different from those found to be fair and reasonable; Provided improper, unreasonable or medically unnecessary treatment or services; Failed to approve or recommend all health care reasonably required for injured employee |
| 3918 | 4/29/2015 | Southeast Service Corporation | Fined $1,000 | Failed to respond to a request for information from TDI-DWC |
| 3934 | 4/28/2015 | QAVU PLLC | Fined $2,000 | Improperly billed an injured employee for workers' compensation medical services provided |
| 3932 | 4/24/2015 | Rodgers, Jerry M.D. | Must not apply for admission to the designated doctor list for three years | Failed to timely file and/or accurately complete TDI-DWC forms, reports and records |
| 3913 | 4/16/2015 | Corley, Ronald G., M.D. | Permanently removed from designated doctor list and MMI/IR certification and may not reapply for designated doctor list | Failed to comply with requirements for designated doctor examinations |
| 3911 | 4/16/2015 | Five Points Health | Fined $1,000 | Improperly billed an injured employee for workers' compensation medical services provided |
| 3912 | 4/16/2015 | Taxis, John O., D.O. | Must not re-apply for designated doctor certification; Must surrender maximum medical improvement/impairment rating credentials | Failed to comply with requirements for documenting impairment rating and designated doctor examinations |
| 3907 | 4/14/2015 | Continental Casualty Company | Fined $3,000 | Failed to timely pay or act on injured employees' request for reimbursement of pharmaceutical expenses |
| 3908 | 4/14/2015 | Liberty Insurance Corporation | Fined $32,000 | Failed to accurately pay income benefits to injured employees; Failed to accurately pay death benefits; Failed to provide accurate claim data to TDI-DWC; Failed to timely pay or act on injured employees' request for reimbursement |
| 3909 | 4/14/2015 | Safety National Casualty Corporation | Fined $5,000 | Failed to timely pay accrued income benefits to an injured employee after receipt of designated doctor's report; Failed to timely pay income benefits to an injured employee |
| 3899 | 4/7/2015 | Mussaji, Murtaza, D.O. | Must not apply for admission to designated doctor list for two years. | Failed to comply with requirements for documenting impairment rating and designated doctor examinations |
| 3891 | 4/2/2015 | Commerce and Industry Insurance Company | Fined $34,000 | Failed to accurately pay income and death benefits; Failed to timely submit claims data to TDI-DWC |
| 3893 | 4/2/2015 | Cummings, Eliseo D.C. | Fined $2,500 | Failed to comply with requirements for the location of designated doctor examinations |
| 3892 | 4/2/2015 | New Hampshire Insurance Company | Fined $19,500 | Failed to timely pay income benefits to injured employee; Failed to timely act on a properly completed medical bill; Failed to properly complete a request for designated doctor examination; Failed to timely comply with TDI-DWC order |
| 3890 | 4/2/2015 | Shaw-Rice, Judi Ann M.D. | Fined $4,000; Must not re-apply for designated doctor certification; Must surrender maximum medical improvement/impairment rating credentials | Failed to inform TDI-DWC of disciplinary actions taken by Texas Medical Board; Failed to timely file designated doctors' reports following examination of injured employees |
| 3879 | 3/30/2015 | Radiology Associates of North Texas | Fined $4,000 | Improperly billed an injured employee for workers' compensation medical services provided |
| 3868 | 3/23/2015 | Atkins, Ernie Lee D.O. | Fined $4,000 | Failed to timely provide designated doctor with injured employee's medical records; Failed to timely comply with a division order to produce documents |
| 3867 | 3/20/2015 | Carter, Jerome Oliver M.D. | Fined $3,000 | Failed to comply with Commissioner rule; Failed to timely respond to request for clarification |
| 3857 | 3/11/2015 | American Zurich Insurance Company | Fined $3,000 | Failed to take final action on a complete medical bill |
| 3856 | 3/11/2015 | Rochdale Insurance Company | Fined $1,600 | Failed to timely comply with order for advance payment of income benefits |
| 3837 | 2/26/2015 | Arrowood Indemnity Company | Fined $13,500 | Failed to timely submit medical bill and payment data to TDI-DWC. |
| 3839 | 2/26/2015 | Employers Assurance Company | Fined $1,200 | Failed to timely pay accrued income benefits after receiving designated doctors certifying report. |
| 3838 | 2/26/2015 | Rayfield, Dennis Scott D.C. | Fined $2,000 | Improperly rescheduled a designated doctor examination; Performed designated doctor examination without reviewing treating doctor's medical records for injured employee. |
| 3822 | 2/18/2015 | ACE American Insurance Company | Total Sanction: $250,000, including an administrative penalty of $100,000; adoption of an enhanced compliance plan, including an investment of at least $50,000 toward implementing the compliance plan; establishment and an initial donation of $100,000 for a Texas branch of the Kids Chance charity, which provides educational opportunities and assistance to families affected by workplace fatalities; and participation in all upcoming TDI-DWC audits for a period of three years. | Failed to timely pay death benefits to eligible beneficiaries; Failed to timely pay interest on accrued death benefits; Failed to timely take action on a request for burial benefits; Failed to timely and accurately notify TDI-DWC of actions taken on a claim. |
| 3823 | 2/18/2015 | Lozano, Pedro Julio D.C. | Fined $1,000 | Failed to document in designated doctor narrative report sufficient explanation of conditions for injured employee to return to work; Failed to file designated doctor narrative report in form and manner required by TDI-DWC. |
| 3819 | 2/17/2015 | The Travelers Indemnity Company | Fined $10,000 | Failed to timely pay income benefits to injured employee; Failed to timely pay benefits based on opinion of designated doctor during pendency of dispute. |
| 3818 | 2/13/2015 | Valley Forge Insurance Company | Fined $30,000 | Failed to pay accurate death benefits to legal beneficiaries; Failed to timely report termination of death benefits to TDI-DWC; Failed to provide accurate claim data to TDI-DWC; Failed to timely pay benefits based on opinion of designated doctor during pendency of a dispute. |
| 3811 | 2/9/2015 | Kersh, Frederick W., D.O. | Must complete maximum medical improvement (MMI) and impairment (IR) certification training within 120 days; must complete core competency workshop; must complete continuing medical education in medical record keeping. | Failed to determine impairment rating (IR) that included injured employee's lumbar vertebral fractures; Administered improper, unreasonable or medically unnecessary treatment or services to injured employee. |
| 3806 | 2/4/2015 | Cho, Mickey Seong M.D. | Must complete designated doctor (DD) training and pass DD certification test within 120 days. | Documented an inadequate designated doctor examination report, including failure to explain analysis performed to establish maximum medical improvement (MMI) date, and failure to analyze specific clinical findings to determine impairment rating (IR) assignments. |
| 3802 | 2/3/2015 | Employers Insurance Company of Wausau | Fined $4,000 | Failed to timely pay income benefits to injured employee. |
| 3800 | 2/3/2015 | Fernando, Savithri M.D. | Fined $1,000; Must complete pharmacology and prescribing training and continuing medical education related to medical guidelines. | Failed to use TDI-DWC adopted MDA return-to-work guidelines to establish goals and return to work plan for safely returning injured employees to work; Failed to document how employee’s injuries prevented return to work; Diagnoses, treatment and evaluations were substantially different from those found fair and reasonable by commissioner. |
| 3801 | 2/3/2015 | Fisher, Deborah M.D. | Must complete continuing medical education in medical record keeping and documentation; Must complete medical training in pharmacology and prescribing. | Diagnoses, treatment or evaluation substantially different from those found fair and reasonable by commissioner; Administered unreasonable or medically unnecessary treatment or services. |
| 3791 | 1/27/2015 | Liberty Insurance Corporation | Fined $20,000 | Failed to timely pay initial temporary income benefits and timely and/or accurately report the initial income benefit payment data to TDI-DWC |
| 3790 | 1/27/2015 | Medical Center of Arlington | Fined $4,000 | Improperly billed an injured employee for workers' compensation medical services provided |
| 3789 | 1/27/2015 | Vargas, Norberto Juan M.D. | Fined $1,000; Must complete medical recordkeeping training | Failed to practice medicine or provide health care consistent with public health, safety and welfare; Administered unreasonable or medically unnecessary treatment or services |
| 3783 | 1/20/2015 | AIG Property Casualty Company | Fined $8,500 | Failed to timely act on a properly completed medical bill; Failed to timely and accurately submit medical electronic data interchange ( EDI) records to TDI-DWC |
| 3784 | 1/20/2015 | American Economy Insurance Company | Fined $4,000 | Failed to timely comply with Medical Fee Dispute Resolution order |
| 3780 | 1/20/2015 | Odom, Timothy E., D.C. | Fined $1,200; Prohibited from applying for admission to designated doctor list or for MMI/IR certification for three years | Failed to timely file and/or accurately complete TDI-DWC forms, reports or records |
| 3781 | 1/20/2015 | Olivares, Adrian D.C. | Fined $1,500 | Failed to timely file and/or accurately complete TDI-DWC forms, reports or records |
| 3782 | 1/20/2015 | Rodrigues, Stephen S., M.D. | Permanently removed from Texas workers' compensation system as a health care provider | Provided diagnoses, treatment or evaluations substantially different from those found to be fair and reasonable by commissioner in Texas workers' compensation system |
| 3772 | 1/12/2015 | Ascension Health | Fined $19,500 | Failed to timely act on a properly completed medical bill; Failed to timely and accurately submit medical electronic data interchange (EDI) records to TDI-DWC |
| 3771 | 1/12/2015 | Thompson, Daniel O., III, M.D. | Fined $3,500; Must cease designated doctor examinations in noncompliant facilities; Must complete designated doctor training | Failed to follow treatment guidelines in designated doctor and maximum medical improvement examinations of injured employees |
| 3773 | 1/12/2015 | Travelers Casualty and Surety Company | Fined $8,000 | Failed to timely pay income benefits to injured employee; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim; Failed to timely report initial payment of income benefits |
| 3774 | 1/12/2015 | Travelers Indemnity Company | Fined $10,000 | Failed to timely pay income benefits to injured employee; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim; Failed timely report initial payment on indemnity benefits |
| 3763 | 1/6/2015 | Alexander, Richard D.C. | Fined $3,000; Must complete continuing education and submit documentation of completion to TDI-DWC | Failed to complete continuing education requirements in previous order; Failed to timely pay administration penalty in previous order |
| 3762 | 1/6/2015 | Illinois National Insurance Company | Fined $8,000 | Failed to timely submit medical bill and payment data to TDI-DWC; Failed to submit accurate medical electronic data interchange (EDI) records to TDI-DWC; Failed to respond to health care provider's request for preauthorization |