Previous Page | Disciplinary Actions Index and Search | News Index

Disciplinary Orders Posted for 2017 | Disciplinary Orders Posted for 2016 | Disciplinary Orders Posted for 2015 | Disciplinary Orders Posted for 2014 | Disciplinary Orders Posted for 2013 | Disciplinary Orders Posted for 2012


Texas State Seal

DISCIPLINARY ORDERS POSTED for 2016

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.

Chevron Corporation of San Ramon, CA
Order Number: DWC-2016-4829
Date of Order:  12/6/2016
Action Taken:  Fined $26,500
Violation:  Failed to accurately submit medical electronic data interchange records to Division; failed to timely process medical bills


Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-2016-4832
Date of Order:  12/6/2016
Action Taken:  Fined $2,000
Violation:  Failed to timely pay income benefits to injured employee


LM Insurance Corporation of Boston, MA
Order Number: DWC-2016-4858
Date of Order:  12/19/2016
Action Taken:  Fined $6,300
Violation:  Failed to timely pay income benefits to injured employee


Property and Casualty Insurance Company of Hartford of Hartford, CT
Order Number: DWC-2016-4830
Date of Order:  12/6/2016
Action Taken:  Fined $2,000
Violation:  Failed to comply with a commissioner order to pay Medical Fee Dispute Resolution Findings and Decision


Ritchie, Mark Alan D.C. of Colleyville, Texas
Order Number: DWC-2016-4845
Date of Order:  12/14/2016
Action Taken:  Fined $5,500; must complete designated doctor case-based training; must compete continuing medical education in ethics
Violation:  Failed to comply with requirements of designated doctor program


Safety First Insurance Company of Saint Louis, MO
Order Number: DWC-2016-4846
Date of Order:  12/14/2016
Action Taken:  Fined $600
Violation:  Failed to timely pay attorney's fees


Technology Insurance Company, Inc. of New York, NY
Order Number: DWC-2016-4833
Date of Order:  12/6/2016
Action Taken:  Fined $6,000
Violation:  Failed to timely pay attorney's fees


Texas Mutual Insurance Company of Austin, Texas
Order Number: DWC-2016-4823
Date of Order:  12/1/2016
Action Taken:  Fined $6,000
Violation:  Failed to timely pay income benefits to injured employee


The Insurance Company of the State of Pennsylvania of New York, NY
Order Number: DWC-2016-4831
Date of Order:  12/6/2016
Action Taken:  Fined $3,000
Violation:  Failed to timely act on a request for reconsideration of a medical bill; failed to timely pay attorney's fees


The Travelers Indemnity Company of Hartford, CT
Order Number: DWC-2016-4822
Date of Order:  12/1/2016
Action Taken:  Fined $1,000
Violation:  Failed to timely comply with a division order


Trumbull Insurance Company of Hartford, CT
Order Number: DWC-2016-4847
Date of Order:  12/14/2016
Action Taken:  Fined $2,000
Violation:  Failed to timely pay income benefits to injured employee


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-2016-4776
Date of Order:  11/4/2016
Action Taken:  Fined $2,500
Violation:  Failed to timely comply with a division order; failed to timely pay income benefits to injured employee


American Casualty Company of Reading, Pennsylvania of Chicago, IL
Order Number: DWC-2016-4777
Date of Order:  11/4/2016
Action Taken:  Fined $30,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries; failed to timely report termination of death benefits to division; provided inaccurate claim data to division


Hartford Casualty Insurance Company of Hartford, CT
Order Number: DWC-2016-4771
Date of Order:  11/2/2016
Action Taken:  Fined $19,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries; failed to timely report termination of death benefits to division


Hartford Underwriters Insurance Company of Hartford, CT
Order Number: DWC-2016-4770
Date of Order:  11/2/2016
Action Taken:  Fined $45,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries; failed to timely notify division of annual lifetime income benefit increases; failed to timely report termination of death benefits to division


Jain, Anjali M.D. of Houston
Order Number: DWC-2016-4775
Date of Order:  11/4/2016
Action Taken:  Fined $76,942; must not participate in treating, examining and/or consulting with other physicians regarding treatment of injured employees in the workers' compensation system
Violation:  Provided health care to injured employees after denied admission to approved doctors list; Received remuneration for treatment of injured employees after denied admission to approved doctors list


Liberty Insurance Corporation of Boston, MA
Order Number: DWC-2016-4778
Date of Order:  11/4/2016
Action Taken:  Fined $7,000
Violation:  Failed to timely pay income benefits to injured employees; failed to timely pay attorney fees


LM Insurance Corporation of Boston, MA
Order Number: DWC-2016-4779
Date of Order:  11/4/2016
Action Taken:  Fined $2,200
Violation:  Failed to timely comply with order of the division


Sentinel Insurance Company, Ltd of Harford, CT
Order Number: DWC-2016-4772
Date of Order:  11/3/2016
Action Taken:  Fined $32,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries; failed to timely notify division of annual lifetime income benefit increases; failed to timely report termination of death benefits to division


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-20164737
Date of Order:  10/21/2016
Action Taken:  Fined $32,500
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


Great Midwest Insurance Company of Houston
Order Number: DWC-20164736
Date of Order:  10/21/2016
Action Taken:  Fined $2,000
Violation:  Failed to timely pay income benefits to injured employee


Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-20164723
Date of Order:  10/12/2016
Action Taken:  Fined $600
Violation:  Failed to timely comply with a division order to pay attorney fees


New Hampshire Insurance Company of New York, NY
Order Number: DWC-2016738
Date of Order:  10/21/2016
Action Taken:  Fined $2,200
Violation:  Failed to comply with a commissioner order in two instances


AIG Assurance Company of New York, NY
Order Number: DWC-20164670
Date of Order:  9/20/2016
Action Taken:  Fined $51,750
Violation:  Failed to timely act on a properly completed medical bill; submitted inaccurate medical electronic data interchange records to division


AIG Property Casualty Company of New York, NY
Order Number: DWC-20164665
Date of Order:  9/20/2016
Action Taken:  Fined $55,800
Violation:  Failed to timely act on a properly completed medical bill; submitted inaccurate medical electronic data interchange records to division


AIU Insurance Company of New York, NY
Order Number: DWC-20164666
Date of Order:  9/20/2016
Action Taken:  Fined $27,180
Violation:  Failed to timely act on a properly completed medical bill; submitted inaccurate medical electronic data interchange records to division


American Fire and Casualty Co of Boston, MA
Order Number: DWC-4647
Date of Order:  9/8/2016
Action Taken:  Fined $20,000
Violation:  Failed to timely act on a properly completed medical bill; submitted inaccurate medical electronic data interchange records to division


American Home Assurance Company of New York, NY
Order Number: DWC-20164668
Date of Order:  9/20/2016
Action Taken:  Fined $9,000
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


American States Insurance Company of Boston, MA
Order Number: DWC-20164681
Date of Order:  9/30/2016
Action Taken:  Fined $27,500
Violation:  Failed to timely act on a properly completed medical bill; submitted inaccurate medical electronic data interchange records to division


Amerisure Partners Insurance Company of Farmington Hills, MI
Order Number: DWC-20164663
Date of Order:  9/20/2016
Action Taken:  Fined $20,000
Violation:  Failed to timely act on a properly completed medical bill; failed to submit accurate medical electronic data interchange records to division


Carter, Jerome Oliver M.D. of Baytown
Order Number: DWC-20164661
Date of Order:  9/20/2016
Action Taken:  Removed from Texas workers' compensation system as health care provider.
Violation:  Provided improper, unreasonable, or medically unnecessary treatment or services to injured employees; Failed to provide health care consistent with public health, safety and welfare


Duclair, Cesar P., M.D. of Fort Worth
Order Number: DWC-4646
Date of Order:  9/8/2016
Action Taken:  Must complete medical records and other training prior to reapplying to be a designated doctor
Violation:  Failed to provide complete report on assessment of injured employee


Federal Insurance Company of Warren, NJ
Order Number: DWC-20164682
Date of Order:  9/30/2016
Action Taken:  Fined $13,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries; failed to timely report termination of death benefits to the division


Houston ISD of Houston
Order Number: DWC-20164662
Date of Order:  9/20/2016
Action Taken:  Fined $1,200
Violation:  Failed to timely pay benefits according to a final order of the division


James Construction Group L.L.C. of Belton
Order Number: DWC-20164683
Date of Order:  9/30/2016
Action Taken:  Fined $2,200
Violation:  Failed to timely pay income benefits to injured employee


New Hampshire Insurance Company of New York City, NY
Order Number: DWC-20164669
Date of Order:  9/20/2016
Action Taken:  Fined $6,000
Violation:  Failed to comply with a division order


Ohio Security Insurance Company of Boston, MA
Order Number: DWC-20164664
Date of Order:  9/20/2016
Action Taken:  Fined $2,530
Violation:  Failed to timely pay income benefits to injured employee; failed to accurately notify division and injured employee of actions taken on a claim


Pritchett, Gary L. D.C. of Hillsboro
Order Number: DWC-20164675
Date of Order:  9/23/2016
Action Taken:  Must not apply for designated doctors list certification for three years
Violation:  Performed examinations of injured employees outside of properly equipped facility; failed to document physical examination of injured employee


Texas Mutual Insurance Company of Austin
Order Number: DWC-4648
Date of Order:  9/8/2016
Action Taken:  Fined $1,000
Violation:  Breached an agreement approved by the division


Travelers Property Casualty Company of America of Hartford, CT
Order Number: DWC-20164680
Date of Order:  9/30/2016
Action Taken:  Fined $62,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries; failed to timely report termination of death benefits to the division


UMC Health System of Lubbock
Order Number: DWC-20164667
Date of Order:  9/20/2016
Action Taken:  Fined $8,000
Violation:  Failed to timely pay income benefits to injured employees; failed to accurately notify division and injured employee of actions taken on a claim


Accident Fund National Insurance Company of Lansing, MI
Order Number: DWC-4632
Date of Order:  8/19/2016
Action Taken:  Fined $2,000
Violation:  Failed to timely pay income benefits to injured employee; failed to accurately notify division and injured employee of actions taken on a claim; failed to notify division on initial payment of benefits


Church Mutual Insurance Company of Merrill, WI
Order Number: DWC-4635
Date of Order:  8/29/2016
Action Taken:  Fined $10,000
Violation:  Failed to timely pay income benefits to injured employee; failed to accurately notify division and injured employee of actions taken on a claim; failed to notify division on initial payment of benefits


City of Corpus Christi of Corpus Christi
Order Number: DWC-4626
Date of Order:  8/16/2016
Action Taken:  Fined $32,000
Violation:  Failed to timely act on a properly completed medical bill; failed to accurately submit medical electronic data interchange records to division


City of Irving of Irving
Order Number: DWC-4636
Date of Order:  8/29/2016
Action Taken:  Fined $2,000
Violation:  Failed to timely comply with order for advance payment of income benefits


HDI Global Insurance Company of Chicago, IL
Order Number: DWC-4613
Date of Order:  8/3/2016
Action Taken:  Fined $1,500
Violation:  Failed to timely comply with division order


Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-4612
Date of Order:  8/3/2016
Action Taken:  Fined $2,500
Violation:  Failed to timely comply with division order


Montgomery County of Conroe
Order Number: DWC-4617
Date of Order:  8/5/2016
Action Taken:  Fined $23,000
Violation:  Failed to timely act on a properly completed medical bill; failed to accurately submit medical electronic data interchange records to division


National American Insurance Company of Chandler, OK
Order Number: DWC-4614
Date of Order:  8/3/2016
Action Taken:  Fined $3,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries; failed to timely notify division of termination of death benefits


National Surety Corporation of Chicago
Order Number: DWC-4618
Date of Order:  8/5/2016
Action Taken:  Fined $5,100
Violation:  Failed to timely act on a properly completed medical bill; failed to accurately submit medical electronic data interchange records to division


Next Page