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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.

Weeks, Trenton David D.C. of Dallas
Order Number: DWC-3572
Date of Order:  10/9/2014
Action Taken:  Fined $1,000; Must complete medical record documentation training
Violation:  Evaluation of injured employee's work status, ability to work, work restrictions and medical condition deficient and lacked testing description or data to support conclusions


American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-3548
Date of Order:  9/18/2014
Action Taken:  Fined $15,500
Violation:  Failed to timely and accurately notify TDI-DWC and injured employee of actions taken on a claim; Failed to timely pay benefits based on opinion of designated doctor during pendency of dispute; Failed to timely act on a properly completed medical bill; ; failed to properly submit request for designated doctor examination


Burgesser, Mary Francis M.D. of Brookfield, WI
Order Number: DWC-3557
Date of Order:  9/23/2014
Action Taken:  Permanently removed from Texas workers' compensation system as a health care provider
Violation:  Provided treatments and/or evaluations substantially different from those found by commissioner to be fair and reasonable which were based on inadequate medical record documentation


Hartford Insurance Company of the Midwest of Hartford, CT
Order Number: DWC-3534
Date of Order:  9/16/2014
Action Taken:  Fined $40,000
Violation:  Failed to pay income benefits in accordance with designated doctors report; Violated and/or failed or refused to comply with commissioner rule or a provision of Texas Workers' Compensation Act


Holland, Christine Westmoreland M.D. of Decatur
Order Number: DWC-3523
Date of Order:  9/9/2014
Action Taken:  Fined $2,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Marshall, C. Perry M.D, of Tyler
Order Number: DWC-3521
Date of Order:  9/9/2014
Action Taken:  Fined $7,500
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


National Interstate Insurance Company of Richfield, OH
Order Number: DWC-3524
Date of Order:  9/9/2014
Action Taken:  Fined $5,000
Violation:  Failed to timely pay income benefits to injured employee based on opinion of designated doctor during pendency of dispute


Safety National Casualty Corporation of St. Louis, MO
Order Number: DWC-3531
Date of Order:  9/15/2014
Action Taken:  Fined $1,000
Violation:  Failed to timely comply with a decision of the commissioner


Siebenaler, Frank J., Jr., D.C. of Austin
Order Number: DWC-3477
Date of Order:  9/9/2014
Action Taken:  Fined $1,000
Violation:  Submitted information to TDI-DWC that misrepresented an accurate and/or consistent certification date for results of designated doctor examination


The Standard Fire Insurance Company of Hartford, CT
Order Number: DWC-3525
Date of Order:  9/9/2014
Action Taken:  Fined $1,500
Violation:  Failed to properly submit request for designated doctor examination


The Travelers Indemnity Company of Hartford, CT
Order Number: DWC-3533
Date of Order:  9/16/2014
Action Taken:  Fined $11,500
Violation:  Failed to issue timely payment to health care provider; Failed to timely act on request for reconsideration


XL Specialty Insurance Company of Stamford, CT
Order Number: DWC-3526
Date of Order:  9/9/2014
Action Taken:  Fined $8,500
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; Failed to timely report initial payment of indemnity benefits to TDI-DWC; Failed to timely act on a properly completed medical bill.


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-3547
Date of Order:  9/18/2014
Action Taken:  Fined $5,500
Violation:  Failed to use TDI-DWC's adopted medical fee guidelines for reimbursement of professional medical service


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-3477
Date of Order:  8/8/2014
Action Taken:  Fined $4,700
Violation:  Failed to timely act on a properly completed medical bill; Failed to timely respond to request from an injured employee; Failed to timely act on request for reconsideration


Behrens Southern Comfort Medical Supply of Galveston
Order Number: DWC-3491
Date of Order:  8/20/2014
Action Taken:  Fined $1,000
Violation:  Improperly billed an injured employee for workers' compensation services provided


Christus Jasper Memorial of Dallas
Order Number: DWC-3492
Date of Order:  8/20/2014
Action Taken:  Fined $2,000
Violation:  Improperly billed an injured employee for workers' compensation services provided


Companion Property and Casualty Insurance Company of Columbia, SC
Order Number: DWC-3494
Date of Order:  8/20/2014
Action Taken:  Fined $28,500
Violation:  Failed to timely process medical bills


Great American Alliance Insurance Company of Cincinnati, OH
Order Number: DWC-3509
Date of Order:  8/27/2014
Action Taken:  Nunc Pro Tunc DWC # 3389
Violation:  Not applicable


Hartford Underwriters Insurance Company of Hartford, CT
Order Number: DWC-3510
Date of Order:  8/27/2014
Action Taken:  Fined $14,000
Violation:  Failed to timely pay income benefits to injured employees


Shade, Ronnie D., M.D. of Dallas
Order Number: DWC-3490
Date of Order:  8/20/2014
Action Taken:  Fined $1,000; Must completed medical records training
Violation:  Failed to use return-to-work guidelines to establish goals and plan with injured employee; Failed to explain in work status report how employee's injury prevented return to work


Texas Health Presbyterian Hospital of Plano of Plano
Order Number: DWC-3493
Date of Order:  8/20/2014
Action Taken:  Fined $4,000
Violation:  Improperly billed and injured employee for workers' compensation services provided


Accident Fund Insurance Company of America of Lansing, MI
Order Number: DWC-3403
Date of Order:  7/10/2014
Action Taken:  Fined $19,000
Violation:  Failed to timely pay income benefits to injured employee; Failed to notify TDI-DWC and injured employee of actions taken on a claim


Ace American Insurance Company of Wilmington, DE
Order Number: DWC-3402
Date of Order:  7/10/2014
Action Taken:  Fined $44,079
Violation:  Failed to submit accurate medical billing and payment data; Failed to timely act on a properly completed medical bill; Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-3420
Date of Order:  7/21/2014
Action Taken:  Fined $4,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit request for designated doctor examination in proper form


Allen I.S.D. of Allen
Order Number: DWC-3419
Date of Order:  7/18/2014
Action Taken:  Fined $12,000
Violation:  Failed to submit accurate medical EDI records to TDI-DWC


American Guarantee and Liability Insurance Company of Schaumburg, IL
Order Number: DWC-3467
Date of Order:  7/31/2014
Action Taken:  Fined $11,000
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, NY
Order Number: DWC-3395
Date of Order:  7/7/2014
Action Taken:  Fined $7,848
Violation:  Failed to submit accurate medical billing and payment data; Failed to timely and accurately notify TDI-DWC of action taken on a claim


Argonaut Insurance Company of San Antonio
Order Number: DWC-3440
Date of Order:  7/28/2014
Action Taken:  Fined $24,000
Violation:  Failed to timely pay income benefits to injured employees as ordered by TDI-DWC


Ascension Health of St. Louis, MO
Order Number: DWC-3439
Date of Order:  7/28/2014
Action Taken:  Fined $5,000
Violation:  Failed to timely pay income benefits to injured employee


Berkshire Hathaway Homestate Insurance Company of Omaha, NE
Order Number: DWC-3404
Date of Order:  7/10/2014
Action Taken:  Fined $32,000
Violation:  Failed to timely act on properly completed medical bill; Failed to accurately submit medical EDI records to TDI-DWC; Failed to timely pay income benefits to injured employee


Bradford Holding Company, Inc. of Beaumont
Order Number: DWC-3441
Date of Order:  7/28/2014
Action Taken:  Fined $17,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI records to TDI-DWC


California Insurance Company of Omaha, NE
Order Number: DWC-3392
Date of Order:  7/7/2014
Action Taken:  Fined $32,000
Violation:  Failed to timely provide services requested by policyholders; Failed to timely act on a properly completed medical bill; Failed to timely submit a accurate medical billing EDI records


Creative Risk Funding, Inc. of Plano
Order Number: DWC-3462
Date of Order:  7/30/2014
Action Taken:  Fined $20,000; Cease and desist from performing utilization review without certificate of registration
Violation:  Utilization review not conducted by licensed physician; Adjuster performing retrospective review of medical doctor visits not properly licensed; Issued medical necessity denials without allowing health care provider reasonable opportunity to discuss with medical doctor


Earle, Stephen Edward M.D. of San Antonio
Order Number: DWC-3469
Date of Order:  7/31/2014
Action Taken:  Removed from Texas workers' compensation system as a health practitioner for five years; Shall not receive direct or indirect remuneration from the Texas workers' compensation system for services performed after date of order
Violation:  Failed to document appropriate justification for intraoperative examinations and procedures performed on injured employees; Failed to document instability and/or need for procedures performed on injured employees


El Paso I.S.D. of El Paso
Order Number: DWC-3405
Date of Order:  7/10/2014
Action Taken:  Fined $6,600
Violation:  Failed to timely notify TDI-DWC of initial payment of income benefits to injured employee; Failed to accurately submit medical billing and payment data to TDI-DWC


General Casualty Company of Wisconsin of Sun Prairie, WI
Order Number: DWC-3423
Date of Order:  7/21/2014
Action Taken:  Fined $12,000
Violation:  Failed to submit accurate medical EDI records to TDI-DWC


Great American Alliance Insurance Company of Cincinnati, OH
Order Number: DWC-3389
Date of Order:  7/7/2014
Action Taken:  Fined $7,500
Violation:  Failed to comply with requirements for initial payment of income benefits to injured employees


Hartford Casualty Insurance Company of Hartford, CT
Order Number: DWC-3429
Date of Order:  7/21/2014
Action Taken:  Fined $1,000
Violation:  Failed to timely pay attorneys fees


Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-3424
Date of Order:  7/21/2014
Action Taken:  Fined $4,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to properly submit request for designated doctor examination


Injury Rehab Clinic of Houston
Order Number: DWC-3525
Date of Order:  7/21/2014
Action Taken:  Fined $2,000
Violation:  Failed to timely respond to request for a refund from an insurance carrier; Failed to timely comply with a TDI-DWC order


Morris, Jerry W., D.O. of Southlake
Order Number: DWC-3387
Date of Order:  7/7/2014
Action Taken:  Voluntarily surrendered and must never re-apply for designated doctor certification in Texas workers' compensation system
Violation:  Failed to timely respond to TDI-DWC request for letter of clarification; Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Neurosurgical Specialists of El Paso, P.L.L. of El Paso
Order Number: DWC-3431
Date of Order:  7/22/2014
Action Taken:  Fined $3,500
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Old Republic Insurance Company of Greensburg, PA
Order Number: DWC-3432
Date of Order:  7/22/2014
Action Taken:  Fined $12,500
Violation:  Failed to pay accurate benefits to injured employee; Failed to notify injured employee and TDI-DWC of actions on a claim; Failed to timely pay attorneys fees


Perez, Abimael M.D. of Corpus Christi
Order Number: DWC-3386
Date of Order:  7/7/2014
Action Taken:  Removed from Texas workers' compensation system as a health care provider
Violation:  Failed to document how treatment provided functional improvement to enhance ability of injured employee to return to work or retain employment; Failed to maintain efficient utilization of health care services to provide meaningful treatment to improve function


QBE Insurance Corporation of New York, NY
Order Number: DWC-3428
Date of Order:  7/21/2014
Action Taken:  Fined $47,000
Violation:  Failed to timely act on a properly completed medical bill; Failed to submit accurate medical EDI records to TDI-DWC


Remirez, Carlos Manuel M.D. of El Paso
Order Number: DWC-3390
Date of Order:  7/7/2014
Action Taken:  Fined $3,000; Must complete medical training approved by TDI-DWC
Violation:  Failed to timely provide health care services by failing to incorporate active physical therapy in addition to medication for injured employee


Sanchez, Mario Alonzo D.O. of La Feria
Order Number: DWC-3400
Date of Order:  7/10/2014
Action Taken:  Fined $1,000; Must complete medical training approved by TDI-DWC
Violation:  Failed to practice medicine or provide health care in an acceptable manner consistent with public health, safety and welfare


Sierra Medical Center of Dallas
Order Number: DWC-3401
Date of Order:  7/10/2014
Action Taken:  Fined $1,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


Southern Vanguard Insurance Company of Houston
Order Number: DWC-3418
Date of Order:  7/18/2014
Action Taken:  Fined $13,500
Violation:  Failed to submit accurate medical billing and payment data to TDI-DWC


Starr Comprehensive Solutions, Inc. of Houston
Order Number: DWC-3466
Date of Order:  7/30/2014
Action Taken:  Fined $25,000
Violation:  Personnel performing retrospective reviews not properly licensed; Issued medical necessity denials without allowing health care provider reasonable opportunity to discuss with medical doctor


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