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Texas State Seal

DISCIPLINARY ORDERS POSTED for 2010

TEXAS DEPARTMENT OF INSURANCE

Division of Workers' Compensation

A Commissioner of Workers' Compensation consent order imposing disciplinary measures becomes final upon signature of the Commissioner of Workers' Compensation. If a Commissioner of Workers' Compensation disciplinary measure is appealed to the State Office of Administrative Hearings (SOAH), an Administrative Law Judge may issue a final decision and order. Final SOAH orders are subject to appeal within 30 days to state district court. If an appeal has not been made within 30 days, the SOAH order becomes final.

Copies of Commissioner of Workers' Compensation orders may be obtained by calling Maria Jimenez at 512-804-4703 or via e-mail to Maria.Jimenez@tdi.texas.gov. Please indicate Disciplinary Orders in the subject line of the request.


Summaries of the orders follow.

Liberty Insurance Corporation of Boston, MA
Order Number: DWC-100087
Date of Order:  10/8/2010
Order Final In:   October
Action Taken:  Fined $153,000
Violation:  Failed to timely pay for preauthorized medical services; Failed to timely process and take final action on a correctly completed request for reconsideration on a medical bill within 21 days; Failed to sufficiently explain reason for denying or reducing payment on a medical bill; Failed to pay temporary income benefits to injured employee; Failed to timely pay impairment income benefits; Failed to take final action on medical bill no later than 45th day after received completed bill


Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC-100088
Date of Order:  10/8/2010
Order Final In:   October
Action Taken:  Fined $50,000
Violation:  Failed to timely process and take final action on a correctly completed request for reconsideration on a medical bill within 21 days; Failed to sufficiently explain reason for denial or reduction of payment on medical bill; Failed to pay for preauthorized medical services; Failed to take final action on medical bill no later than 45th day after received completed bill; Failed to timely pay temporary income benefits to injured employee


Liberty Mutual Insurance Company of Boston, MA
Order Number: DWC-100085
Date of Order:  10/8/2010
Order Final In:   October
Action Taken:  Fined $17,000
Violation:  Failed to accept communication in absence of DWC Form-001 as notice of injury and failed to contact employer within seven days of notification; Failed to timely pay supplemental income benefits; Failed to timely pay Division order or Commissioner order; Failed to solicit request for safety information or assistance from policyholder


LM Insurance Corporation of Boston, MA
Order Number: DWC-1000086
Date of Order:  10/8/2010
Order Final In:   October
Action Taken:  Fined $30,000
Violation:  Improperly denied payment for preauthorized medical services; Failed to timely process and take final action on a correctly completed request for reconsideration on a medical bill within 21 days; Failed to sufficiently explain denial or reduction of payment on a medical bill; Failed to pay temporary income benefits to an injured employee


Massenburg, Bryan M.D. of Longview
Order Number: DWC-100089
Date of Order:  10/8/2010
Order Final In:   October
Action Taken:  Fined $12,000; Must attend Division educational course on roles and responsibilities of health care providers;
Violation:  Failed to timely file DWC Form-069 with the insurance carrier (92 instances); Failed to file the DWC Form-069 with carrier via facsimile or electronic transmission (92 instances)


Southern Vanguard Insurance Company of Dallas
Order Number: DWC-100091
Date of Order:  10/19/2010
Order Final In:   October
Action Taken:  Fined $15,000
Violation:  Failed to initiate payment of temporary income benefits or file a notice of refusal; Inaccurately reported to the Division actions taken on a claim; Failed to timely process and take final action on a correctly completed request for reconsideration on a medical bill within 21 days


West Houston Radiology Associates of Houston
Order Number: DWC-100093
Date of Order:  10/22/2010
Order Final In:   October
Action Taken:  Fined $2,500
Violation:  Billed injured employee for medical treatments or services when carrier not relieved of liability for costs of health care and injured employee did not violate Labor Code


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-10-0079
Date of Order:  9/16/2010
Order Final In:   September
Action Taken:  Fined $74,000
Violation:  Failed to pay medical costs related to an emergency or treatments/services that require preauthorization when preauthorized; Failed to timely respond to request for preauthorization


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-10-0080
Date of Order:  9/16/2010
Order Final In:   September
Action Taken:  Fined $147,000
Violation:  Failed to comply with decision or order of the TDI-DWC Commissioner; Failed to pay indemnity benefits; Failed to timely pay medical benefits; Failed to pay medical bills according to TDI-DWC Medical Fee Guidelines


Holleman, James F., Jr. D.O. of Tyler
Order Number: DWC-10-0078
Date of Order:  9/10/2010
Order Final In:   September
Action Taken:  Cease and desist from providing health care services in the workers' compensation system
Violation:  Failed to follow current guidelines for evaluation of expected or average return-to-work timeframes; Failed to provide reasonable and necessary care to injured employee; Failed to maintain efficient utilization of health care


Methodist Hospital of Cincinnati, OH
Order Number: DWC-10-0083
Date of Order:  9/29/2010
Order Final In:   September
Action Taken:  Fined $8,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Najera, Raul Abel M.D. of Dallas
Order Number: DWC-10-0074
Date of Order:  9/3/2010
Order Final In:   September
Action Taken:  Fined $2,000
Violation:  Failed to file DWC Form-69 in a timely manner; Failed to timely file a narrative report; Failed to timelyl respond to a Letter of Clarification


Refaeian, Manouchehr M.D. of Austin
Order Number: DWC-10-0081
Date of Order:  9/29/2010
Order Final In:   September
Action Taken:  Fined $20,000; Suspended from Designated Doctor List for six months beginning December 1, 2010
Violation:  Failed to timely file DWC Form-69 with TDI-DWC (133 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic transmission (136 instances)


Shanti, Ihsan M.D. of Houston
Order Number: DWC-10-0073
Date of Order:  9/3/2010
Order Final In:   September
Action Taken:  Withdrawal from practicing in the Texas workers' compensation system
Violation:  License to practice medicine revoked, suspended or not renewed by appropriate licensing or certification authority; Sought payment for medical services which were not rendered


Southwestern Bell Telephone, LP of Dallas
Order Number: DWC-10-0072
Date of Order:  9/3/2010
Order Final In:   September
Action Taken:  Fined $3,500
Violation:  Failed to take final action on a medical bill not later than the 45th day after the date complete medical bill received; Violated administrative rules by providing notice disputing future medical benefits


Standard Fire Insurance Company of Hartford, CT
Order Number: DWC-10-0071
Date of Order:  9/3/2010
Order Final In:   September
Action Taken:  Fined $8,000
Violation:  Failed to timely issue initial Temporary Income Benefits (TIBs); Failed to timely report initial TIBs payments; Failed to accurately report First Dates of Disability


Voge, Victoria M. M.D. of Round Rock
Order Number: DWC-10-0082
Date of Order:  9/29/2010
Order Final In:   September
Action Taken:  Fined $5,000; Must maintain current appointment location matrix for six months; Must attend educational conference on roles and responsibilities of health care providers in workers' compensation system
Violation:  Failed to file DWC Form-69 in timely manner; Failed to timely file DWC Form-69 with insurance carrier; Failed to notify TDI-DWC with time and date of rescheduled appointment


Advantage Workers Compensation Insurance Company of Salt Lake City, UT
Order Number: DWC-10-0065
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


Atlin, Neil J. D.O. of Dallas
Order Number: DWC-10-0059
Date of Order:  8/6/2010
Order Final In:   August
Action Taken:  Agreed to attend a pain management course and to forward to the Division all documentation that was submitted to the carriers for preauthorization requests for initial implantation of spinal cord stimulators and/or pain pumps after he receives the carriers' approval or denial. The agreement to attend this course is not an admission or evidence of fault with respect to the validity of any claim or defense, or the amount of any claim by any of the parties, concerning the matters in controversy. The purpose of the provision regarding preauthorizations is to generally evaluate and improve the preauthorization process involving spinal cord stimulators and pain pumps.
Violation:  The Division alleged that Dr. Atlin misdiagnosed cases, he failed to document his diagnoses with physical exam findings, he provided improper treatment, and he delivered excessive, unnecessary, unreasonable medical treatment that did not meet professionally recognized standards of care. Dr. Atlin provided a response and submitted documentation, complete medical records, and reports from certified pain management specialists that he believes provides evidence that his diagnosis and treatment of the patients was proper, well documented and met professionally recognized standards.


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: DWC-10-0067
Date of Order:  8/25/2010
Order Final In:   August
Action Taken:  Fined $175,000
Violation:  Failure to comply with workers' compensation system adminstrative rules and procedures (43 instances)


King County Emergency Medical Services of Guthrie
Order Number: DWC-10-0058
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 adminstrative rules and procedures


Northern Insurance Company of New York of Schaumburg, IL
Order Number: DWC-10-0055
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: DWC-10-0066
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: DWC-10-0056
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: DWC-10-0057
Date of Order:  8/3/2010
Order Final In:   August
Action Taken:  Fined $5,000
Violation:  Failed to timely pay or dispute benefits


Daniels, Michael M.D. of Arlington
Order Number: DWC-10-0046
Date of Order:  7/5/2010
Order Final In:   July
Action Taken:  Fined $2,500; Must complete training
Violation:  Failed to timely file DWC Form-69 with insurance carrier; Failed to file DWC Form-69 with the carrier via facsimile or electronic submission


Driver Pipeline Company, Inc. of Irving
Order Number: DWC-10-0051
Date of Order:  7/22/2010
Order Final In:   July
Action Taken:  Fined $12,000
Violation:  Failed to timely pay benefits ordered by TDI-DWC


Jafarnia, Kourosh Korsh M.D. of Houston
Order Number: DWC-10-0052
Date of Order:  7/22/2010
Order Final In:   July
Action Taken:  Must not reapply for authorization to certify maximum medical improvement and assign impairment ratings for one year
Violation:  Failed to timely file DWC Form-69 with insurance carrier (18 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic submission (23 instances)


American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-10-0035
Date of Order:  6/4/2010
Order Final In:   June
Action Taken:  Fined $30,000
Violation:  Failed to pay for preauthorized medical services; Failed to comply with TDI-DWC or Commissioner Order (four instances); Failed to timely process medical bills; Failed to submit accurate data to TDI-DWC (10 instances)


Clogston, Curtis M.D. of San Marcos
Order Number: DWC-10-0039
Date of Order:  6/16/2010
Order Final In:   June
Action Taken:  Fined $8,000; Must provide copy of compliance plan; Must complete training
Violation:  Failed to timely file the DWC Form-69 with insurance carrier (62 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic submission (62) instances; Failed to timely file letter of clarification; Refused four or more designated doctor appointments in 90 days


Dolgencorp of Texas, Inc. of Goodlettsville, TN
Order Number: DWC-10-0041
Date of Order:  6/30/2010
Order Final In:   June
Action Taken:  Fined $32,000
Violation:  Failed to notify injured worker of actions taken on claim; Failed to begin to pay benefits as required or timely file notice of denial of compensability; Failed to timely initiate TIBs; Failed to take timely action on medical bill; Failed to accurately submit medical bill and payment data to TDI-DWC


Federal Insurance Company of Warren, NJ
Order Number: DWC-10-0043
Date of Order:  6/30/2010
Order Final In:   June
Action Taken:  Fined $30,000; Must submit compliance plan
Violation:  Improper denial of payment for preauthorized medical services (two instances); Failed to timely act on medical bills; Failed to timely pay TIBs in accordance with Designated Doctor's report; Failed to timely pay for services deemed necessary in Independent Review Organization decision.


Hartford Casualty Insurance Company of Hartford, CT
Order Number: DWC-10-0044
Date of Order:  6/30/2010
Order Final In:   June
Action Taken:  Fined $42,000
Violation:  Failed to pay for preauthorized medical services; Failed to timely respond to a request for preauthorization; Failed to provide sufficient explanation for denial of payment for medical services; Failed to timely initiate TIBs (30 instances); Failed to submit accurate data to TDI-DWC (78 instances)


Hartford Insurance Company of the Midwest of Hartford, CT
Order Number: DWC-10-0045
Date of Order:  6/30/2010
Order Final In:   June
Action Taken:  Fined $50,000
Violation:  Failed to notify TDI-DWC and injured employee of actions taken on claim; Filed to timely pay benefits or file notice of denial; Failed to timely initiate payment of TIBs; Failed to timely act on properly completed medical bill; Failed to pay for preauthorized medical services; Failed to accurately submit medical bill and payment data to TDI-DWC


Netherlands Insurance Company of Boston, MA
Order Number: DWC-10-0037
Date of Order:  6/4/2010
Order Final In:   June
Action Taken:  Fined $6,000
Violation:  Failed to comply with TDI-DWC ordered advance within seven days of receipt of order


The Travelers Indemnity Company of Connecticut of Hartford, CT
Order Number: DWC-10-0040
Date of Order:  6/24/2010
Order Final In:   June
Action Taken:  Fined $250,000
Violation:  Failed to timely forward Independent Review Organization requests to TDI


Toledo, Luiz M.D. of Fort Worth
Order Number: DWC-10-0038
Date of Order:  6/16/2010
Order Final In:   June
Action Taken:  Fined $5,000; Provide copy of compliance plan; Must complete training
Violation:  Failed to timely file DWC Form-69 with insurance carrier (91 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic submission


Vredenburgh, Jesse W. D.O. of Portland
Order Number: DWC-10-0042
Date of Order:  6/30/2010
Order Final In:   June
Action Taken:  Fined $5,000; Must limit locations for designated doctor examinations for one year; Must complete training
Violation:  Failed to timely reexamine injured employee; Failed to timely file DWC Form-69 with TDI-DWC (101) instances; Failed to timely file letter of clarification (six instances)


Weeks, Trenton M.D. of Flower Mound
Order Number: DWC-10-0036
Date of Order:  6/4/2010
Order Final In:   June
Action Taken:  Fined $5,000; Suspended from Designated Doctor List for three months
Violation:  Failed to timely file DWC Form-69 with insurance carrier (37 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic submission (41 instances)


Drazner, Bryan M.D. of Dallas
Order Number: DWC-10-0034
Date of Order:  5/10/2010
Order Final In:   May
Action Taken:  Fined $15,000; Suspended from Designated Doctor List for six months
Violation:  Failed to timely file DWC Form-69 with insurance carrier (72 instances); Failed to provide documentation proving filing of DWC Form-69 (40 instances); Failed to timely file letter of clarification


Ninala, Ranil M.D. of Dallas
Order Number: DWC-10-0033
Date of Order:  5/10/2010
Order Final In:   May
Action Taken:  Fined $6,000
Violation:  Failed to timely file DWC Form-69 with insurance carrier (26 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic transmission (14 instances);


Onabajo, Catherine Eno Okpon M.D. of Lewisville
Order Number: DWC-10-0032
Date of Order:  5/10/2010
Order Final In:   May
Action Taken:  Fined $1,000; Suspended from Designated Doctor List for six months;
Violation:  Failed to timely reschedule Designated Doctor appointment; Failed to timely notify injured employee of rescheduled appointment; Failed to timely file narrative report with insurance carrier; Failed to timely file DWC Form-69 with the TDI-DWC (23 instances); Failed to timely file letter of clarification (seven instances)


Albrand, Otmar M.D. of Austin
Order Number: DWC-10-0028
Date of Order:  4/30/2010
Order Final In:   April
Action Taken:  Fined $10,000; Must implement compliance plans submitted to the TDI-DWC
Violation:  Failed to timely file letter of clarification (two instances); Failed to timely file DWC Form-069 with the TDI-DWC (four instances); Failed to timely notify injured employee of appointment changes; Failed to timely conduct re-examination pursuant to letter of clarification request


Driggers, Kimberley D.C. of New Braunfels
Order Number: DWC-10-0026
Date of Order:  4/30/2010
Order Final In:   April
Action Taken:  Cease and desist from practicing before the TDI-DWC as health care practitioner for 10 years
Violation:  Failed to timely file required medical records; Failed to timely comply with TDI-DWC order to produce medical records


Frazier, M. Lewis Jr., M.D. of Plano
Order Number: DWC-10-0027
Date of Order:  4/30/2010
Order Final In:   April
Action Taken:  Fined $5,000; Suspended from Designated Doctor List for six months; Must complete existing designated doctor assignments; Must timely respond to TDI-DWC requests for letters of clarification; Must submit a compliance plan to TDI-DWC.
Violation:  Failed to timely file the DWC Form-069 with the TDI-DWC (five instances)


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