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DISCIPLINARY ORDERS POSTED for 2011

TEXAS DEPARTMENT OF INSURANCE

Division of Workers' Compensation

A Commissioner of Workers’ Compensation consent order (settlement) imposing sanctions becomes final upon signature of the Commissioner of Workers’ Compensation. System participants are entitled to a hearing at the State Office of Administrative Hearings (SOAH) if they do not wish to settle the enforcement matter. If there is a hearing on an enforcement matter at SOAH, the SOAH Administrative Law Judge will issue a Proposal for Decision (PFD). The Commissioner of Workers’ Compensation will then consider the case, and shall issue a decision or order that may become final. The decision or order that may become final will become final in accordance with Government Code chapter 2001, subchapters F and G.

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.

Dodge, William David M.D. of Dallas
Order Number: DWC-11-0046
Date of Order:  4/12/2011
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


Downey, Sara D.C. of Grand Prairie
Order Number: DWC-11-0047
Date of Order:  4/25/2011
Action Taken:  Take an AADEP-sponsored medical examination and submit score to Division; Designated Doctor examinations will be monitored provided by AADEP; Must submit Designated Doctor examinations for review
Violation:  Failed to provide an explanation for the date of Maximum Medical Improvement (MMI); Failed to assign an impairment rating in accordance with applicable guidelines


East Texas Educational Insurance Association of Tyler
Order Number: DWC-11-0049
Date of Order:  4/25/2011
Action Taken:  Fined $7,000
Violation:  Failed to comply with an order or decision of the Commissioner


Rose, James Keith M.D. of Corpus Christi
Order Number: DWC-11-0045
Date of Order:  4/12/2011
Action Taken:  Fined $1,000; Must attend compliance training for doctors and medical staff
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Southwest General Emergency Physicians, PLLC of Hollywood, FL
Order Number: DWC-11-0048
Date of Order:  4/25/2011
Action Taken:  Fined $1,000
Violation:  Improperly billed an injured employee for workers’ compensation medical services provided


Tarrant County College District of Fort Worth
Order Number: DWC-11-0050
Date of Order:  4/25/2011
Action Taken:  Fined $3,500
Violation:  Reported inaccurate billing data to Division


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-11-0028
Date of Order:  3/3/2011
Action Taken:  Nunc Pro Tunc
Violation:  Please see Order Number DWC 11-0011


American Home Assurance Company of New York NY
Order Number: DWC-11-0032
Date of Order:  3/3/2011
Action Taken:  Fined $11,000
Violation:  Failed to pay for preauthorized medical services; Failed to timely respond to an injured employee's request for reimbursement of travel expenses


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-110030
Date of Order:  3/3/2011
Action Taken:  Fined $4,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely pay medical bill; Failed to timely act on request for reconsideration of a medical bill


Begia, Bruce C., M.D. of San Antonio
Order Number: DWC-110040
Date of Order:  3/11/2011
Action Taken:  Fined $1,000; Must attend compliance training for doctors and medical staff
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Bumagin, Michael S. M.D. of Fort Worth
Order Number: DWC-110027
Date of Order:  3/3/2011
Action Taken:  Removed from Designated Doctor List; Maximum Medical Improvement and Impairment Rating certifications revoked
Violation:  Failed to assign Impairment Ratings in accordance with the American Medical Association Guides to Permanent Impairment


Crockett, James D.O. of Marlin
Order Number: DWC-110043
Date of Order:  3/24/2011
Action Taken:  Removed from participation in workers' compensation system as health care provider for 10 years
Violation:  Provided diagnoses and treatments found to be improper, unfair and/or unreasonable and not supported by documentation and/or physical examination of injured employee


Dallas National Insurance Company, A Texas Stock Insurance Company of Dallas
Order Number: DWC-110042
Date of Order:  3/22/2011
Action Taken:  Fined $9,000
Violation:  Failed to pay for preauthorized medical services; Failed to timely pay income benefits to injured employee


Davis, Carl Cuthbert Jr., M.D. of Houston
Order Number: DWC-110031
Date of Order:  3/3/2011
Action Taken:  Fined $1,250; Suspended from Designated Doctor's List of 90 days; Must attend compliance training for doctors and medical staff
Violation:  Failed to timely file letter of clarification; Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Hartford Fire Insurance Company of Hartford, CT
Order Number: DWC-110035
Date of Order:  3/3/2011
Action Taken:  Fined $5,000
Violation:  Failed to reasonably and prudently process claims ; Failed to provide written notification of claims experience; Failed to provide written notification of loss analysis; Failed to provide mandatory on-site visit to policyholders


Hartford Insurance Company of the Midwest of Hartford, CT
Order Number: DWC-110034
Date of Order:  3/3/2011
Action Taken:  Fined $4,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to provide written notification of claims experience


Horoda, Michael Johnathan, M.D. of Fort Worth
Order Number: DWC-110029
Date of Order:  3/3/2011
Action Taken:  Fined $3,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Houston Northwest Emergency Specialists, PLLC of Houston
Order Number: DWC-110039
Date of Order:  3/7/2011
Action Taken:  Fined $4,000
Violation:  Improperly billed an injured employee for workers’ compensation medical services provided


Moczygemba, Roger M., M.D. of San Antonio
Order Number: DWC-110041
Date of Order:  3/22/2011
Action Taken:  Fined $3,000; Must attend compliance training for doctors and medical staff
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Osborne, William (Phillip) M.D. of Houston
Order Number: DWC-110044
Date of Order:  3/24/2011
Action Taken:  Fined $4,500; Must attend compliance training for doctors and medical staff
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


TASB Risk Management Fund of Austin
Order Number: DWC-110036
Date of Order:  3/3/2011
Action Taken:  Fined $5,000
Violation:  Failed to timely pay income benefits to injured employee


Transportation Insurance Company of Chicago, IL
Order Number: DWC-110033
Date of Order:  3/3/2011
Action Taken:  Fined $10,000
Violation:  Retrospectively reviewed medical necessity of preauthorized medical service or treatment; Failed to pay for preauthorized medical services


Wan, Christine Wyman M.D. of Odessa
Order Number: DWC-110037
Date of Order:  3/3/2011
Action Taken:  Fined $1,000; Must attend compliance training for doctors and medical staff
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Wolski, Edward, M.D. DBA Wol+Med of Denton
Order Number: DWC-110038
Date of Order:  3/7/2011
Action Taken:  Fined $5,000
Violation:  Filed unwarranted complaints against system participants


Anderson, C. Lynn M.D. of Brownsville
Order Number: DWC-11-0022
Date of Order:  2/11/2011
Action Taken:  Fined $6,000; 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


Liberty Insurance Corporation of Boston, MA
Order Number: DWC-11-0021
Date of Order:  2/11/2011
Action Taken:  Fined $1,000
Violation:  Failed to timely pay income benefits to injured employee


Liberty Mutual Insurance Company of Boston, MA
Order Number: DWC-11-0023
Date of Order:  2/21/2011
Action Taken:  Fined $3,000
Violation:  Failed to comply with Commissioner’s order to pay advance temporary income benefits


LM Insurance Corporation of Boston, MA
Order Number: DWC-110020
Date of Order:  2/11/2011
Action Taken:  Fined $18,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to pay correct income benefit amount; Failed to timely pay medical bill


Memorial Hermann Hospital System d/b/a Memorial Hermann Katy Hospital of Katy
Order Number: DWC-11-0024
Date of Order:  2/21/2011
Action Taken:  Fined $6,000
Violation:  Improperly billed an injured employee for workers’ compensation medical services provided


Methodist Hospital of San Antonio
Order Number: DWC-11-0025
Date of Order:  2/21/2011
Action Taken:  Fined $6,000
Violation:  Improperly billed an injured employee for workers’ compensation medical services provided


Rosenstein, Jacob M.D. of Arlington
Order Number: DWC-110018
Date of Order:  2/3/2011
Action Taken:  Consent Order
Violation:  Relating to quality of health care provided to injured employees in workers' compensation system


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-110011
Date of Order:  1/26/2011
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
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American Casualty Company of Reading, Pennsylvania of Chicago, IL
Order Number: DWC-110005
Date of Order:  1/10/2011
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
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
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
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
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
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-11-0002
Date of Order:  1/10/2011
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
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, FL
Order Number: DWC-110017
Date of Order:  1/28/2011
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, OH
Order Number: DWC-110014
Date of Order:  1/26/2011
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
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
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
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


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