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Texas State Seal

DISCIPLINARY ORDERS POSTED for 2011

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.

Dodge, William David M.D. of Dallas
Order Number: DWC-11-0046
Date of Order:  4/12/2011
Order Final In:   April
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
Order Final In:   April
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
Order Final In:   April
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
Order Final In:   April
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
Order Final In:   April
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
Order Final In:   April
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   March
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
Order Final In:   February
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
Order Final In:   February
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
Order Final In:   February
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
Order Final In:   February
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
Order Final In:   February
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
Order Final In:   February
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
Order Final In:   February
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
Order Final In:   January
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
Order Final In:   January
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
Order Final In:   January
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
Order Final In:   January
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
Order Final In:   January
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
Order Final In:   January
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
Order Final In:   January
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
Order Final In:   January
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
Order Final In:   January
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
Order Final In:   January
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
Order Final In:   January
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
Order Final In:   January
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
Order Final In:   January
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
Order Final In:   January
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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