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DISCIPLINARY ORDERS POSTED for 2012

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.

Charter Oak Fire Insurance Company of Hartford, CT
Order Number: DWC-2081
Date of Order:  12/3/2012
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Action Taken:  Fined $9,500
Violation:  Failed to timely pay income benefits to injured employee


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