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DISCIPLINARY ORDERS POSTED for 2012

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.

Charter Oak Fire Insurance Company of Hartford, CT
Order Number: DWC-2081
Date of Order:  12/3/2012
Order Final In:   December
Action Taken:  Fined $2,000
Violation:  Failed to timely pay income benefits to injured employee


Commerce and Industry Insurance Company of New York, NY
Order Number: DWC-2103
Date of Order:  12/11/2012
Order Final In:   December
Action Taken:  Fined $2,500
Violation:  Failed to tender the full payment of death benefits to legal beneficiaries at the rate set out in the statute


Fort Worth Club of Fort Worth
Order Number: DWC-2135
Date of Order:  12/20/2012
Order Final In:   December
Action Taken:  Fined $500
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Genghis Grill of College Station
Order Number: DWC-2083
Date of Order:  12/3/2012
Order Final In:   December
Action Taken:  Fined $600
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Insight Health Corporation of Atlanta, GA
Order Number: DWC-2082
Date of Order:  12/3/2012
Order Final In:   December
Action Taken:  Fined $4,000
Violation:  Improperly billed an injured employee for workers compensation medical services provided


Joe Brand, Inc. of Laredo
Order Number: DWC-2134
Date of Order:  12/20/2012
Order Final In:   December
Action Taken:  Fined $1,000
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Johnson, Keith M.D. of San Antonio
Order Number: DWC-2132
Date of Order:  12/20/2012
Order Final In:   December
Action Taken:  Fined $2,900
Violation:  Failed to timely file and accurately complete TDI-DWC forms, reports or records


New Hampshire Insurance Company of New York, NY
Order Number: DWC-2133
Date of Order:  12/20/2012
Order Final In:   December
Action Taken:  Fined $16,000
Violation:  Failed to comply with a division to pay attorneys’ fees; denied preauthorized medical services for medical necessity; and inaccurately reported the place of service codes for facility medical bills


Patino, Louis D.C. of McAllen
Order Number: DWC-2123
Date of Order:  12/11/2012
Order Final In:   December
Action Taken:  Fined $55,000 (SOAH Docket No. 454-11-4712.C1)
Violation:  Received indirect renumeration from the treatment of workers' compensation system claimants after denied placement on approved doctor's list


Service Lloyds Insurance Company of Austin
Order Number: DWC-2111
Date of Order:  12/14/2012
Order Final In:   December
Action Taken:  Fined $20,000
Violation:  Failed to accurately submit medical bill and payment data


Sonic Clear Lake Volkswagen, LP of Houston
Order Number: DWC-2104
Date of Order:  12/11/2012
Order Final In:   December
Action Taken:  Fined $750
Violation:  Failed to comply timely with a request for information and a division order to produce information regarding the filing of DWC forms


Texoma Specialty Care Center of Denison
Order Number: DWC-2084
Date of Order:  12/3/2012
Order Final In:   December
Action Taken:  Fined $500
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Travelers Casualty and Surety Company of Hartord, CT
Order Number: DWC-2080
Date of Order:  12/3/2012
Order Final In:   December
Action Taken:  Fined $6,000
Violation:  Failed to notify TDI-DWC and injured employee of actions taken on a claim


Vantage Trailers, Inc. of Katy
Order Number: DWC-2089
Date of Order:  12/5/2012
Order Final In:   December
Action Taken:  Fined $1,000
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Williams, Clyde Marion M.D. of Amarillo
Order Number: DWC-2105
Date of Order:  12/11/2012
Order Final In:   December
Action Taken:  Fined $2,500
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Beman, Douglas L., D.C. of Fort Worth
Order Number: DWC-2070
Date of Order:  11/26/2012
Order Final In:   November
Action Taken:  Fined $5,000; Must submit to monitoring-based medical quality review
Violation:  Failed to provide treatment plan for injured employee; Failed to oversee efficient use of care provided to injured employee


Bituminous Casualty Corporation of Rock Island, IL
Order Number: DWC-2018
Date of Order:  11/6/2012
Order Final In:   November
Action Taken:  Fined $6,600
Violation:  Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange


Capitol Emergency Associates, P.A. of Oklahoma City, OK
Order Number: DWC-2028
Date of Order:  11/8/2012
Order Final In:   November
Action Taken:  Fined $1,000
Violation:  Improperly billed an injured employee for workers compensation medical services provided


Chubb Indemnity Insurance Company of Warren, NJ
Order Number: DWC-2034
Date of Order:  11/13/2012
Order Final In:   November
Action Taken:  Fined $3,000
Violation:  Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange


Church Mutual Insurance Company of Merrill, WI
Order Number: DWC-2035
Date of Order:  11/13/2012
Order Final In:   November
Action Taken:  Fined $3,960
Violation:  Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange


Core 400, L.L.C. of Austin
Order Number: DWC-2016
Date of Order:  11/6/2012
Order Final In:   November
Action Taken:  Must comply with compliance plan approved by TDI-DWC medical advisor
Violation:  Failed to follow TDI-DWC guidelines in performing independent review of injured worker health care


Fireman's Fund Insurance Company of Novato, CA
Order Number: DWC-2074
Date of Order:  11/27/2012
Order Final In:   November
Action Taken:  Fined $3,500
Violation:  Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange


Hinman, Charles Rhodes M.D. of Austin
Order Number: DWC-2073
Date of Order:  11/26/2012
Order Final In:   November
Action Taken:  Fined $1,500
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


IRO Express, Inc. of Arlington
Order Number: DWC-2019
Date of Order:  11/3/2012
Order Final In:   November
Action Taken:  Must comply with compliance plan approved by TDI-DWC medical advisor
Violation:  Failed to follow TDI-DWC guidelines in performing independent review of injured worker health care


LRA Global HR, Inc. of Tampa, FL
Order Number: DWC-2013
Date of Order:  11/6/2012
Order Final In:   November
Action Taken:  Fined $1,000
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Pacific Indemnity Company of Warren, NJ
Order Number: DWC-2036
Date of Order:  11/13/2012
Order Final In:   November
Action Taken:  Fined $3,000
Violation:  Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange


Pure Resolutions, L.L.C. of Mansfield
Order Number: DWC-2017
Date of Order:  11/6/2012
Order Final In:   November
Action Taken:  Must comply with compliance plan approved by TDI-DWC medical advisor
Violation:  Failed to follow TDI-DWC guidelines in performing independent review of injured worker health care


Rainwater, Noble Bryan M.D. of Houston
Order Number: DWC-2076
Date of Order:  11/27/2012
Order Final In:   November
Action Taken:  Fined $1,000
Violation:  Failed to timely file required reports


SOI-31 of AR, Incorporated of Charlotte, NC
Order Number: DWC-2072
Date of Order:  11/26/2012
Order Final In:   November
Action Taken:  Fined $1,500
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


True Decisions, Inc. of Austin
Order Number: DWC-2014
Date of Order:  11/6/2012
Order Final In:   November
Action Taken:  Must comply with compliance plan approved by TDI-DWC medical advisor
Violation:  Failed to follow TDI-DWC guidelines in performing independent review of injured worker health care


University Hospital Systems, L.L.P. of Houston
Order Number: DWC-2071
Date of Order:  11/26/2012
Order Final In:   November
Action Taken:  Fined $1,500
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


Webb County of Laredo
Order Number: DWC-2029
Date of Order:  11/8/2012
Order Final In:   November
Action Taken:  Fined $15,000
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely submit medical bill and payment data


Williams, Robert Seth M.D. of Kyle
Order Number: DWC-2075
Date of Order:  11/27/2012
Order Final In:   November
Action Taken:  Fined $1,500
Violation:  Failed to timely file required reports


Albrand, Otmar Wolf M.D. of Kyle
Order Number: DWC-12-0171
Date of Order:  10/12/2012
Order Final In:   October
Action Taken:  Suspended from Designated Doctor List
Violation:  Failed to perform additional relevant testing or to refer injured employee to other health care providers to determine medical issue; Improperly determined impairment rating


American Hardware Mutual Insurance Company of Columbus, OH
Order Number: DWC-12-0178
Date of Order:  10/17/2012
Order Final In:   October
Action Taken:  Fined $3,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Baker, Gregory Wayne D.C. of Pasadena
Order Number: DWC-12-0174
Date of Order:  10/17/2012
Order Final In:   October
Action Taken:  Removed from Designated Doctor List; Deprived of right to certify maximum medical improvement and/or assign impairment ratings in the workers' compensation system
Violation:  Performed a designated doctor examination without appointment from TDI-DWC


Bradford Holding Company, Inc. of Corpus Christi
Order Number: DWC-12-0183
Date of Order:  10/29/2012
Order Final In:   October
Action Taken:  Fined $21,000
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely pay medical bill or to pay medical bill according to TDI-DWC Medical Fee Guidelines


Capitol City Insurance Company of New York, NY
Order Number: DWC-12-0169
Date of Order:  10/12/2012
Order Final In:   October
Action Taken:  Fined $2,500
Violation:  Failed to notify TDI-DWC and injured employee of actions taken on a claim; Failed to accurately submit medical bill and payment data


City of Arlington of Arlington
Order Number: DWC-12-0177
Date of Order:  10/17/2012
Order Final In:   October
Action Taken:  Fined $11,500
Violation:  Failed to accurately submit medical bill and payment data


Dish Network Corporation of Conroe
Order Number: DWC-12-0167
Date of Order:  10/5/2012
Order Final In:   October
Action Taken:  Fined $3,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records; Failed to comply with order or decision of Commissioner or TDI-DWC


Hartford Insurance Company of the Midwest of Hartford, CT
Order Number: DWC-12-0186
Date of Order:  10/29/2012
Order Final In:   October
Action Taken:  Fined $5,000
Violation:  Failed to accurately submit medical bill and payment data


Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-12-0185
Date of Order:  10/29/2012
Order Final In:   October
Action Taken:  Fined $6,960
Violation:  Failed to accurately submit medical bill and payment data


Lumbermen's Underwriting Alliance of Boca Raton, FL
Order Number: DWC-12-0184
Date of Order:  10/29/2012
Order Final In:   October
Action Taken:  Fined $4,600
Violation:  Failed to accurately submit medical bill and payment data


Meridian Security Insurance Company of Indianapolis, IN
Order Number: DWC-12-0176
Date of Order:  10/17/2012
Order Final In:   October
Action Taken:  Fined $34,300
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely pay medical bill or to pay medical bill according to TDI-DWC Medical Fee Guidelines


National American Insurance Company of Chandler, OK
Order Number: DWC-12-0187
Date of Order:  10/29/2012
Order Final In:   October
Action Taken:  Fined $5,760
Violation:  Failed to accurately submit medical bill and payment data


Petroleum Casualty Company of Austin
Order Number: DWC-12-0188
Date of Order:  10/29/2012
Order Final In:   October
Action Taken:  Fined $2,400
Violation:  Failed to accurately submit medical bill and payment data


Praetorian Insurance Company of New York, NY
Order Number: DWC-12-0170
Date of Order:  10/12/2012
Order Final In:   October
Action Taken:  Fined $30,000
Violation:  Failed to timely pay medical bill or to pay medical bill according to TDI-DWC Medical Fee Guidelines; Failed to accurately submit medical bill and payment data


Soignier, Wayne A., M.D. of Kyle
Order Number: DWC-12-0173
Date of Order:  10/17/2012
Order Final In:   October
Action Taken:  Permanently removed from designated doctor list
Violation:  Failed to perform TDI-DWC ordered designated doctor examinations in accordance with AMA Guidelines; Submitted inaccurate or incomplete reports; Failed to follow statutes and rules for designated doctor appointments and reporting to TDI-DWC


Southern Vanguard Insurance Company of Dallas
Order Number: DWC-12-0166
Date of Order:  10/5/2012
Order Final In:   October
Action Taken:  Fined $15,500
Violation:  Failed to accurately submit medical bill and payment data; Failed to timely pay medical bill or to pay medical bill according to TDI-DWC Medical Fee Guidelines


Sparta Insurance Company of Hartford, CT
Order Number: DWC-12-0168
Date of Order:  10/5/2012
Order Final In:   October
Action Taken:  Fined $9,500
Violation:  Failed to timely pay income benefits to injured employee


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