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DISCIPLINARY ORDERS POSTED for 2013

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 Insurance and or Commissioner of Workers' Compensation orders may be obtained only by an open records request. Your request can be sent by email, fax, mail, or in person. Learn more about how to request information.


Summaries of the orders follow.

Alvarado, Hilario III, M.D. of San Antonio
Order Number: DWC-2903
Date of Order:  12/16/2013
Action Taken:  Fined $2,000
Violation:  Refused to accept a TDI-DWC appointment to perform a subsequent designated doctor examination on one injured employee


Gonzales, Mary Anastasia M.D. of Austin
Order Number: DWC-2901
Date of Order:  12/16/2014
Action Taken:  Fined $500; Must complete one-day designated doctor workshop
Violation:  Failed to correctly apply AMA Guides; Failed to document adequately in one designated doctor examination


Jarolimek, Lubor Jan M.D. of Houston
Order Number: DWC-2902
Date of Order:  12/16/2013
Action Taken:  Fined $1,000; Must complete a one-day designated doctor workshop
Violation:  Failed to correctly apply the AMA Guides; ordered an unnecessary medical test; Failed to document an adequate narrative report


Sanders, Mark Seltzer M.D. of Houston
Order Number: DWC-2900
Date of Order:  12/16/2014
Action Taken:  Permanently surrendered designated doctor certification and certification to assign maximum medical improvement and impairment ratings
Violation:  Failed to comply with a TDI-DWC Order for Production; Ordered an unnecessary medical test as part of a designated doctor examination


Smith, Stephen L., D.O. of Fredericksburg
Order Number: DWC-2910
Date of Order:  12/17/2013
Action Taken:  Must complete designated doctor training and pass the certification test in no more than three attempts; upon timely passing the designated doctor certification test, must participate in medical quality review monitoring review and pay $15,000 fine
Violation:  Failed to comply with TDI-DWC decisions and orders; Designated doctor assessments of injured employees overturned by contested case hearings; Used inflammatory and inappropriate language in his designated doctor reports for injured employees; Designated doctor examination's diagnoses, evaluations, and impairment ratings were substantially different from those that Commissioner finds to be fair and reasonable; Did not address the issues as ordered by TDI-DWC in the form and manner prescribed; Misrepresented or omitted pertinent facts in his medical evaluations and narrative reports; Submitted a charge for health care that was not furnished; Failed to perform a complete physical examination for purpose of determining MMI and IR; Failed to timely file and/or accurately complete TDI-DWC forms, reports or records.


Austin Total Healthcare of Austin
Order Number: DWC-2834
Date of Order:  11/5/2013
Action Taken:  Fined $3,000
Violation:  Failed to respond to request for refund from an insurance carrier; Failed to timely comply with a TDI-DWC order


Deiter, Cary Thomas D.C. of El Paso
Order Number: DWC-2848
Date of Order:  11/19/2013
Action Taken:  Fined $3,000; Must complete continuing education hours approved by TDI-DWC
Violation:  Administered improper, unreasonable or medically unnecessary treatment or services


Farmers Insurance Exchange of Los Angeles, CA
Order Number: DWC-2845
Date of Order:  11/8/2013
Action Taken:  Fined $1,000
Violation:  Failed to provide on-site visit or other appropriate services to three policyholders with a premium greater than $25,000 within a 12 month period


Griffith, David M., D.C. of San Antonio
Order Number: DWC-2835
Date of Order:  11/5/2013
Action Taken:  Fined $3,000; Must complete continuing education hours approved by TDI-DWC
Violation:  Failed to document subjective and objective functional improvement gains for injured worker


Kaufman, James K., M.D. of Fort Worth
Order Number: DWC-2865
Date of Order:  11/22/2013
Action Taken:  Removed from the Texas Workers' Compensation system as a health care practitioner
Violation:  Performed surgeries without demonstratable pathology or benefit to be derived from surgery


Kordestani, Rouzebeh K., M.D. of Amarillo
Order Number: DWC-2863
Date of Order:  11/22/2013
Action Taken:  Voluntary and permanent surrender of designated doctor certification and certification to assign maximum medical improvement dates and impairment ratings
Violation:  Failed to obtain TDI-DWC approval prior to changing location of a designated doctor examination; Failed to follow proper procedure to reschedule a designated doctor exam; Failed to comply with a DWC Order for Production; Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Plano Independent School District of Plano
Order Number: DWC-2864
Date of Order:  11/22/2013
Action Taken:  Fined $2,500
Violation:  Improperly withheld funds from injured employee's salary


Stephenson, Jackie Dean M.D. of San Antonio
Order Number: DWC-2850
Date of Order:  11/19/2013
Action Taken:  Removed from Texas Workers' Compensation system as a health care practitioner as of December 31, 2013
Violation:  Failed to provide health care reasonably required by nature of injury and needed to promote recovery; Failed to maintain an efficient utilization of health care through extensive and prolonged treatment without adequate documentation


Strickland, Mark Joseph, D.C. of Copeville
Order Number: DWC-2866
Date of Order:  11/22/2013
Action Taken:  Fined $2,500
Violation:  Failed to maintain efficient utilization of medical care through documentation and record keeping; Provided improper, unreasonable or medically unnecessary treatment or services


Alexander, Richard A., D.C. of San Antonio
Order Number: DWC-2827
Date of Order:  10/28/2013
Action Taken:  Must complete continuing education hours approved by TDI-DWC
Violation:  Administered improper or unreasonable treatment or services -- treatment plan did not enhance ability of injured employee to return to work


Cole, George M., D.O. of Dallas
Order Number: DWC-2826
Date of Order:  10/28/2013
Action Taken:  Fined $500; must complete designated doctor core competency workshop within 90 days
Violation:  Failed to include required information in a designated doctor examination narrative report


Jensen, Jack Edward M.D. of Houston
Order Number: DWC-2796
Date of Order:  10/3/2013
Action Taken:  Fined $2,000
Violation:  Failed to timely respond to two requests for letters of clarification


Texas Automobile Dealers Self Insurers Group of Austin
Order Number: DWC-2828
Date of Order:  10/28/2013
Action Taken:  Fined $1,000
Violation:  Failed to timely pay benefits to injured employee


The Insurance Company of the State of Pennsylvania of New York, NY
Order Number: DWC-2825
Date of Order:  10/28/2013
Action Taken:  Fined $2,200
Violation:  Submitted inaccurate medical EDI records; Failed to timely pay and ordered benefit advance; failed to timely notify TDI-DWC of change in benefit type, termination of income benefits


Williams, Clyde Marion M.D. of Amarillo
Order Number: DWC-2795
Date of Order:  10/3/2013
Action Taken:  Nunc Pro Tunc Order
Violation:  Corrects two clerical errors in Order No. 2105 regarding DWC forms filed and reduces fine


Adair Grain Company of West
Order Number: DWC-2789
Date of Order:  9/30/2013
Action Taken:  Fined $500
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


American Hallmark Insurance Company of Texas of Austin
Order Number: DWC-2736
Date of Order:  9/5/2013
Action Taken:  Fined $6,000
Violation:  Failed to accurately submit medical records via electronic data interchange


Chadadeh, Hassan M.D. of Houston
Order Number: DWC-2735
Date of Order:  9/5/2013
Action Taken:  Fined $5,000; Must complete physician assessment and clinical education course (PACE)
Violation:  Failed to sufficiently document justification for prescriptions


Dallas National Insurance Company of Dallas
Order Number: DWC-2767
Date of Order:  9/17/2013
Action Taken:  Fined $12,500
Violation:  Failed to timely pay income benefits and accrued interest to an injured employee according to a contested case hearing decision and order


MedRisk, Inc. of King of Prussia, PA
Order Number: DWC-2746
Date of Order:  9/12/2013
Action Taken:  Fined $17,500
Violation:  Failed to remit full amount reimbursed by the insurance carrier to the health care provider


Pacific Indemnity Company of Warren, NJ
Order Number: DWC-2766
Date of Order:  9/17/2013
Action Taken:  Fined $17,500
Violation:  Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange; Failed to timely pay income benefits to injured employee


Retailers Casualty Insurance Company of Alexandria, LA
Order Number: DWC-2748
Date of Order:  9/12/2013
Action Taken:  Fined $9,000
Violation:  Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange


Tarrant County College District of Fort Worth
Order Number: DWC-2747
Date of Order:  9/12/2013
Action Taken:  Fined $15,000
Violation:  Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange


Vigilant Insurance Company of Warren, NJ
Order Number: DWC-2768
Date of Order:  9/18/2013
Action Taken:  Fined $6,500
Violation:  Failed to submit accurate medical bill data to TDI-DWC


AAA Cooper Transportation of Dothan, AL
Order Number: DWC-2730
Date of Order:  8/30/2013
Action Taken:  Fined $5,000
Violation:  Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange


ACIG Insurance Company of Dallas
Order Number: DWC-2682
Date of Order:  8/2/2013
Action Taken:  Fined $10,000
Violation:  Failed to timely pay income benefits to injured employee


Bangale, Anil T., M.D. of Fort Worth
Order Number: DWC-2680
Date of Order:  8/2/2013
Action Taken:  Fined $5,000
Violation:  Quality of health care provided not in compliance with statutory requirements; Failed to report a disciplinary action on Designated Doctor application


Burke, Douglas William D.C. of San Antonio
Order Number: DWC-2709
Date of Order:  8/23/2013
Action Taken:  Fined $5,000; Must complete continuing education course on following medical guidelines
Violation:  Provided treatment not in accord with applicable treatment guidelines and not within the standard of care


East Texas Educational Insurance Association of Tyler
Order Number: DWC-2710
Date of Order:  8/23/2013
Action Taken:  Fined $2,000
Violation:  Failed to timely report medical electronic data interchange (EDI) records to TDI-DWC


Ebeade, Samir S., M.D. of Orange
Order Number: DWC-2720
Date of Order:  8/26/2013
Action Taken:  Must cease designated doctor examinations at a specific location and must request the location for examinations be deleted from TDI-DWC system
Violation:  Failed to use a properly equipped medical facility for designated doctor examinations


El Paso County Hospital District of El Paso
Order Number: DWC-2708
Date of Order:  8/23/2013
Action Taken:  Fined $11,000
Violation:  Failed to accurately and timely submit electronic data interchange (EDI) records to TDI-DWC


Florists' Mutual Insurance Company of Edwardsville, IL
Order Number: DWC-2707
Date of Order:  8/23/1013
Action Taken:  Fined $2,500
Violation:  Failed to accurately submit medical bill and payment data


Harlandale Independent School District of San Antonio
Order Number: DWC-2724
Date of Order:  8/28/2013
Action Taken:  Fined $4,000
Violation:  Failed to timely comply with a TDI-DWC order


Kestler, Bryan Claude D.C. of Port Lavaca
Order Number: DWC-2718
Date of Order:  8/26/2013
Action Taken:  Fined $1,000
Violation:  Failed to comply with Texas Workers' Compensation Act


ORR, Inc. of Texarkana
Order Number: DWC-2681
Date of Order:  8/2/2013
Action Taken:  Fined $1,000
Violation:  Failed to comply with Commissioner's Order to provide requested information about workers' compensation coverage status


West Rest Haven, Inc. of West
Order Number: DWC-2725
Date of Order:  8/28/2013
Action Taken:  Fined $1,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports, or records


Amerisure Partners Insurance Company of Farmington Hills, MI
Order Number: DWC-2651
Date of Order:  7/17/2013
Action Taken:  Fined $13,500
Violation:  Failed to accurately submit medical bill and payment data to TDI-DWC


Bates, Aaron M.D. of Fleming Island, FL
Order Number: DWC-2649
Date of Order:  7/17/2013
Action Taken:  Permanently cease from participating or practicing in Texas workers' compensation system
Violation:  Failed to appropriately evaluate injured employee assigned


El Paso County Community College of El Paso
Order Number: DWC-2656
Date of Order:  7/17/2013
Action Taken:  Fined $6,000
Violation:  Failed to accurately submit medical bill and payment data to TDI-DWC


GuideOne Mutual Insurance Company of West Des Moines, IA
Order Number: DWC-2678
Date of Order:  7/30/2013
Action Taken:  Fined $10,000
Violation:  Failed to accurately report electronic data interchange (EDI) medical billing data to TDi-DWC


Labrock Materials, Inc. of Euless, TX
Order Number: DWC-2667
Date of Order:  7/25/2013
Action Taken:  Fined $5,000
Violation:  Failed to timely comply with Commissioner's Order to provide requested information about workers' compensation coverage status


MacMaster, Benzel Christopher M.D. of Dallas
Order Number: DWC-2655
Date of Order:  7/17/2013
Action Taken:  Fined $2,000
Violation:  Failed to adequately document required information in a peer review report


Markel Insurance Company of Glen Allen, VA
Order Number: DWC-2652
Date of Order:  7/17/2013
Action Taken:  Fined $4,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to notify TDI-DWC and injured employee of actions taken on a claim


Protective Insurance Company of Indianapolis, IN
Order Number: DWC-2665
Date of Order:  7/25/2013
Action Taken:  Fined $30,000
Violation:  Failed to provide required claims experience and documentation of loss analysis to policyholders


Texas Mutual Insurance Company of Austin
Order Number: DWC-2666
Date of Order:  7/25/2013
Action Taken:  Fined $6,500
Violation:  Failed to timely pay an advance ordered by TDI-DWC; Failed to timely provide injured employee records to designated doctor; Failed to accurately report benefit data to TDI-DWC or accurately submit benefit data by electronic data interchange


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