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DISCIPLINARY ORDERS POSTED for 2014

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.

Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-3743
Date of Order:  12/19/2014
Action Taken:  Fined $1,000
Violation:  Failed to provide list of all injured worker injuries determined to be compensable by TDI-DWC or as accepted as compensable by insurance carrier


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-3696
Date of Order:  12/2/2014
Action Taken:  Fined $700
Violation:  Failed to timely comply with an order for advance payment of income benefits to injured employee


Chubb Indemnity Insurance Company of Warren, NJ
Order Number: DWC-3714
Date of Order:  12/11/2014
Action Taken:  Fined $9,000
Violation:  Failed to timely pay benefits based on the opinion of designated doctor during pendency of a dispute


City of Houston of Houston
Order Number: DWC-3752
Date of Order:  12/23/2014
Action Taken:  Fined $8,000
Violation:  Failed to comply with benefit dispute agreement


Dallas Medical Center of Dallas
Order Number: DWC-3695
Date of Order:  12/2/2014
Action Taken:  Fined $15,000
Violation:  Failed to respond to a request for a refund from insurance carrier


Eaves, Jason L., D.C. of San Antonio
Order Number: DWC-3729
Date of Order:  12/18/2014
Action Taken:  Fined $1,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


El Paso Orthopedic Surgery Center of El Paso
Order Number: DWC-3730
Date of Order:  12/18/2014
Action Taken:  Fined $2,000
Violation:  Improperly billed an injured employee for wrokers' compensation medical services provided


Everest National Insurance Company of Liberty Corner, NJ
Order Number: DWC-3742
Date of Order:  12/19/2014
Action Taken:  Fined $25,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to timely submit accurate medical EDI records to TDI-DWC


Federal Insurance Company of Warren, NJ
Order Number: DWC-3713
Date of Order:  12/11/2014
Action Taken:  Fined $4,000
Violation:  Failed to timely pay income benefits to injured employee


Genesis Insurance Company of Stamford, CT
Order Number: DWC-3741
Date of Order:  12/19/2014
Action Taken:  Fined $35,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI bills to TDI-DWC


Great Midwest Insurance Company of Houston
Order Number: DWC-3740
Date of Order:  12/19/2014
Action Taken:  Fined $3,400
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim


Kinnison, David Wayne D.C. of North Richland Hills
Order Number: DWC-3739
Date of Order:  12/19/2014
Action Taken:  Fined $1,000; Cannot apply or reapply for certification as a designated doctor until after March 31, 2017
Violation:  Failed to timely respond to request for clarification


Liberty Insurance Corporation of Irving
Order Number: DWC-3697
Date of Order:  12/2/2014
Action Taken:  Fined $9,000
Violation:  Failed to pay benefits in accordance with designated doctor's opinion; Failed to timely comply with TDI-DWC decision and order


Medical Center of Arlington of Arlington
Order Number: DWC-3731
Date of Order:  12/18/2014
Action Taken:  Fined $4,000
Violation:  Improperly pursued a private claim against an employer; Failed to comply with an Order to Produce


New Hampshire Insurance Company of New York, NY
Order Number: DWC-3698
Date of Order:  12/2/2014
Action Taken:  Fined $89,000
Violation:  Failed to timely submit accurate medical bill and payment EDI records to TDI-DWC; Failed to timely pay income benefits to injured employee; Failed to take action on a properly completed medical bill; Failed to timely process a travel reimbursement request; Failed to timely process a completed medical bill; Failed to timely submit accurate medical EDI records to TDI-DWC; Failed to timely provide information requested by an injured employee; Failed to timely pay attorney's fees; Failed to provide list of all injured worker injuries determined to be compensable by TDI-DWC or as accepted as compensable by insurance carrier; Failed to timely pay in accordance with a Benefit Dispute Agreement; Failed to report to TDI-DWC the initial payment of income benefits


Phoenix Insurance Company of Hartford, CT
Order Number: DWC-3732
Date of Order:  12/18/2014
Action Taken:  Fined $5,750
Violation:  Failed to timely pay temporary income benefits to injured employee; Failed to accurately report income benefits data to TDI-DWC


Prentice, Kevin Lee D.C. of Lewisville
Order Number: DWC-3694
Date of Order:  12/2/2014
Action Taken:  Fined $2,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Property and Casualty Insurance Company of Hartford of Hartford, CT
Order Number: DWC-3749
Date of Order:  12/22/2014
Action Taken:  Fined $8,000
Violation:  Failed to timely pay benefits in accordance with designated doctor's opinion


Protective Insurance Company of Carmel, IN
Order Number: DWC-3699
Date of Order:  12/2/2014
Action Taken:  Fined $9,000
Violation:  Failed to timely pay temporary income benefits to injured employee; Failed to timely notify TDI-DWC and injured employee of actions taken on a claim


Quiroz, Juan Francisco M.D. of Sunnyvale
Order Number: DWC-3690
Date of Order:  12/1/2014
Action Taken:  Fined $750
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


SeaBright Insurance Company of Seattle, WA
Order Number: DWC-3744
Date of Order:  12/19/2014
Action Taken:  Fined $16,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to timely submit accurate medical EDI records to TDI-DWC


Sentry Casualty Company of Stevens Point, WI
Order Number: DWC-3745
Date of Order:  12/19/2014
Action Taken:  Fined $4,400
Violation:  Failed to timely pay temporary income benefits to injured employee; Failed to accurately report benefits and payment data to TDI-DWC


Starr Indemnity & Liability Company of New York, NY
Order Number: DWC-3751
Date of Order:  12/23/2014
Action Taken:  Fined $5,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to accurately notify TDI-DWC and injured employee of actions taken on a claim


Technology Insurance Company of New York, NY
Order Number: DWC-3733
Date of Order:  12/18/2014
Action Taken:  Fined $9,000
Violation:  Failed to timely pay temporary income benefits to injured employee; Failed to timely notify TDI-DWC and injured employee of actions taken on a claim


Texas Mutual Insurance Company of Austin
Order Number: DWC-3746
Date of Order:  12/19/2014
Action Taken:  Fined $12,000
Violation:  Failed to timely comply with a commissioner's order to produce information; Failed to notify the division of refusal to pay a medical bill; Failed to timely pay impairment benefits based on a designated doctor's opinion


Texas Public School Workers' Compensation Project of Plano
Order Number: DWC-3700
Date of Order:  12/2/2014
Action Taken:  Fined $7,500
Violation:  Failed to timely pay income benefits to injured employee; Failed to timely notify TDI-DWC and injured employee of actions taken on a claim


Twin City Fire Insurance Company of Hartford, CT
Order Number: DWC-3701
Date of Order:  12/2/2014
Action Taken:  Fined $3,000
Violation:  Failed to comply with TDI-DWC order


Valley Forge Insurance Company of Chicago, IL
Order Number: DWC-3748
Date of Order:  12/19/2014
Action Taken:  Fined $6,000
Violation:  Failed to timely pay temporary income benefits to injured employee; Failed to accurately report initial temporary income data to TDI-DWC


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-3712
Date of Order:  12/11/2014
Action Taken:  Fined $3,400
Violation:  Failed to timely issue payment to health care provider


Accident Fund General Insurance Company of Lansing, MI
Order Number: DWC-3671
Date of Order:  11/18/2014
Action Taken:  Fined $28,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI records to TDI-DWC


American Home Assurance Company of New York City, NY
Order Number: DWC-3672
Date of Order:  11/18/2014
Action Taken:  Fined $2,000
Violation:  Failed to timely act on a properly completed medical bill


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-3673
Date of Order:  11/18/2014
Action Taken:  Fined $10,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to timely submit accurate medical EDI records to TDI-DWC


Beman, Douglas L., D.C. of Fort Worth
Order Number: DWC-3683
Date of Order:  11/19/2014
Action Taken:  Fined $1,000; Must complete medical training
Violation:  Failed to provide acceptable health care to injured employee including: Improperly utilized diagnostic tests not supported by medical record or evidence-based criteria


Halaby, Gerald A., M.D. of Houston
Order Number: DWC-3670
Date of Order:  11/18/2014
Action Taken:  Must complete medical training including required designated doctor certification
Violation:  Failed to provide acceptable care to injured employee including meeting minimum requirements of designated doctors


Mayorga, Gilbert, Jr., M.D. of Houston
Order Number: DWC-3669
Date of Order:  11/18/2014
Action Taken:  Fined $5,000; Must complete assigned CME courses within 180 days
Violation:  Failed to adequately assess and monitor injured employees in four cases when prescribing opioids; Failed to establish return-to-work goals


Pacific Indemnity Company of Warren, NJ
Order Number: DWC-3674
Date of Order:  11/18/2014
Action Taken:  Fined $3,000
Violation:  Failed to timely act on a properly completed medical bills; Failed to submit accurate medical EDI records to TDI-DWC


Sparta Insurance Company of Hartford, CT
Order Number: DWC-3675
Date of Order:  11/18/2014
Action Taken:  Fined $15,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI records to TDI-DWC


The Netherlands Insurance Company of Boston, MA
Order Number: DWC-3684
Date of Order:  11/19/2014
Action Taken:  Fined $6,000
Violation:  Failed to timely pay benefits to injured employee; Failed to submit accurate payment data to TDI-DWC


Work First Casualty Company of Wilmington, DE
Order Number: DWC-3676
Date of Order:  11/18/2014
Action Taken:  Fined $6,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI records to TDI-DWC


Ace American Insurance Company of Wilmington, DE
Order Number: DWC-3598
Date of Order:  10/22/2014
Action Taken:  Fined $45,000
Violation:  Failed to accurately and timely pay benefits to an injured employee; Failed to accurately pay death benefits; Failed to notify TDI-DWC and injured employee of actions taken on a claim


Caldwell, Rodney Lynn M.D. of Dallas, TX
Order Number: DWC-3591
Date of Order:  10/22/2014
Action Taken:  Fined $3,600
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Cherokee Insurance Company of Sterling Heights, MI
Order Number: DWC-3594
Date of Order:  10/22/2014
Action Taken:  Fined $10,000; Must submit required medical EDI data
Violation:  Failed to timely submit medical bill and payment data via EDI to TDI-DWC


Corpus Christi I.S.D. of Corpus Christi
Order Number: DWC-3595
Date of Order:  10/22/2014
Action Taken:  Fined $3,000
Violation:  Failed to timely issue payment of supplemental income benefits to an injured employee in a subsequent quarter


Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC-3596
Date of Order:  10/22/2014
Action Taken:  Fined $2,500
Violation:  Failed to comply with TDI-DWC order to provide information for a designated doctor examination


Marshall, George Kenneth M.D. of Longview
Order Number: DWC-3592
Date of Order:  10/22/2014
Action Taken:  Must not accept new patients in nor participate in Texas workers' compensation system as a health care provider; Must refer existing patients to other providers
Violation:  Administered improper, unreasonable, or medically unnecessary treatment by treating an injured employee for a diagnosis not supported by the medical record


Newton, Lesley M.D. of Houston
Order Number: DWC-3593
Date of Order:  10/22/2014
Action Taken:  Agrees not to re-apply for designated doctor list nor to apply to certify maximum medical improvement and assign impairment ratings for two years
Violation:  Failed to timely file proper forms and narrative reports following five designated doctor examinations


OneBeacon America Insurance Company of Canton, MA
Order Number: DWC-3573
Date of Order:  10/9/2014
Action Taken:  Fined $5,500
Violation:  Submitted inaccurate medical EDI records to TDI-DWC


Pacific Employers Insurance Company of Philadelphia, PA
Order Number: DWC-3574
Date of Order:  10/9/2014
Action Taken:  Fined $3,000
Violation:  Improperly denied reimbursement based on medical necessity for preauthorized health care


Tarrant County College District of Austin
Order Number: DWC-3575
Date of Order:  10/9/2014
Action Taken:  Fined $9,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI records to TDI-DWC


The Insurance Company of the State of Pennsylvania of New York City, NY
Order Number: DWC-3597
Date of Order:  10/22/2014
Action Taken:  Fined $6,500
Violation:  Failed to timely submit medical bill and payment data via EDI to TDI-DWC; Failed to timely act on an injured employee's request for travel reimbursement


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