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DISCIPLINARY ORDERS POSTED for 2017

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.

Federated Service Insurance Company of Owatonna, MN
Order Number: DWC-5317
Date of Order:  12/15/2017
Action Taken:  Fined $6,400
Violation:  Failed to timely pay income benefits to injured employees; failed to accurately notify the division of actions taken on a claim


State Farm Fire and Casualty Company of Bloomington, IL
Order Number: DWC-5312
Date of Order:  12/12/2017
Action Taken:  Fined $11,000
Violation:  Failed to timely act on a properly completed medical bill; failed to submit accurate medical electronic data interchange records to the division


Battle, Clinton C., M.D. of Fort Worth
Order Number: DWC-20185295
Date of Order:  11/29/2017
Action Taken:  Removed from the Texas workers' compensation system as health care provider
Violation:  Prescribed compound medications that were improper, unreasonable or medically unnecessary; failed to follow the division's fee and treatment guidelines; failed to document reasons for prescribing compound medications


Chubb Indemnity Insurance Company of Whitehouse Station, NJ
Order Number: DWC-20185268
Date of Order:  11/1/2017
Action Taken:  Fined $2,500
Violation:  Failed to comply with a division order


Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC-20185294
Date of Order:  11/29/2017
Action Taken:  Fined $1,250
Violation:  Failed to timely pay income benefits to an injured employee after receiving a designated doctor's report


LM Insurance Corporation of Boston, MA
Order Number: DWC-20185269
Date of Order:  11/1/2017
Action Taken:  Fined $2,500
Violation:  Failed to timely pay income benefits to an injured employee after receiving a designated doctor's report


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-20185259
Date of Order:  10/18/2017
Action Taken:  Fined $950
Violation:  Failed to timely act on a request for reconsideration


Kobza, Paul Edward D.O. of The Woodlands
Order Number: DWC-20185247
Date of Order:  10/10/2017
Action Taken:  Complete pharmacology and prescribing and medical documentation training
Violation:  Prescribed compounded medications that were improper, unreasonable or medically unnecessary; failed to document medical necessity or appropriate medical rationale for prescribing compounded medications


Levy, Richard Simon M.D. of Dallas
Order Number: DWC-20185260
Date of Order:  10/18/2017
Action Taken:  Fined $1,500; must subscribe to MD Guidelines; must complete medical record documentation training; must complete return to work training.
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records; failed to consider MD Guidelines when assessing return to work; failed to provide adequate description or explanation injury prevented employee from returning to work


LM Insurance Corporation of Boston
Order Number: DWC-20185246
Date of Order:  10/10/2017
Action Taken:  Fined $2,500
Violation:  Failed to comply with commissioner order


New Hampshire Insurance Company of New York, NY
Order Number: DWC-20185248
Date of Order:  10/10/2017
Action Taken:  Fined $3,000
Violation:  Failed to comply with commissioner order


United States Fire Insurance Company of Morristown, NJ
Order Number: DWC-20185245
Date of Order:  10/10/2017
Action Taken:  Fined $1,250
Violation:  Failed to take final action on a properly completed medical bill.


Ace American Insurance Company of Philadelphia, PA
Order Number: DWC-20175175
Date of Order:  8/3/2017
Action Taken:  Fined $5,255
Violation:  Failed to pay accurate death benefits to legal beneficiaries


Keepers, Jerry M., M.D. of Friendswood
Order Number: DWC-20175170
Date of Order:  8/2/2017
Action Taken:  Fined $5,000; must complete training; must document medical necessity for prescribing compound medications
Violation:  Prescribed compound medications that were improper, unreasonable or medically unnecessary


LaMarra, Anthony J., DPM of Houston
Order Number: DWC-20175169
Date of Order:  8/2/2017
Action Taken:  Fined $7,500; must cease and desist from prescribing compound medications as a routine practice in the Texas Workers' Compensation System; must complete medical training
Violation:  Prescribed compound medications that were improper, unreasonable or medically unnecessary


Sreshta, Dominic Gregory M.D. of Sugar Land
Order Number: DWC-20175189
Date of Order:  8/22/2017
Action Taken:  Fined $6,250; must complete medical training; must document medical necessity for compound medication to improve injured employee's symptoms
Violation:  Prescribed compound medications that were improper, unreasonable or medically unnecessary; failed to document reasons for prescribing compounded medications


Texas Mutual Insurance Company of Austin
Order Number: DWC-20175174
Date of Order:  8/3/2017
Action Taken:  Fined $1,000
Violation:  Failed to comply with division order regarding benefits


ACIG Insurance Company of Dallas
Order Number: DWC-20175142
Date of Order:  7/6/2017
Action Taken:  Fined $10,000
Violation:  Failed to timely pay income benefits to injured employee


American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-20175157
Date of Order:  7/18/2017
Action Taken:  Fined $4,000
Violation:  Failed to timely pay income benefits to injured employee; failed to comply with a division order


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-20175156
Date of Order:  7/18/2017
Action Taken:  Fined $5,000
Violation:  Failed to timely pay income benefits to injured employee


Hartford Underwriters Insurance Company of Hartford, CT
Order Number: DWC-20175140
Date of Order:  7/6/2017
Action Taken:  Fined $3,000
Violation:  Failed to timely act on a properly completed medical bill


Mitsui Sumitomo Insurance Company of America of Warren, NJ
Order Number: DWC-20175153
Date of Order:  7/18/2017
Action Taken:  Fined $500
Violation:  Failed to timely comply with an interlocutory order


National Union Fire Insurance Company of Pittsburgh, PA of New York, NY
Order Number: DWC-20175155
Date of Order:  7/18/2017
Action Taken:  Fined $1,500
Violation:  Failed to comply with agreement approved by division


Sazy, John Anthony M.D. of Arlington
Order Number: DWC-20175141
Date of Order:  7/6/2017
Action Taken:  Must complete continuing medical education hours
Violation:  Failed to document medical conditions requiring prescription of "N" drugs; failed to document pain levels or success of prescribed drugs; failed to document the medical necessity for the "N" drugs prescribed; and failed to document his rationale for prescribing certain drugs


Trumbull Insurance Company of Hartford, CT
Order Number: DWC-20175139
Date of Order:  7/6/2017
Action Taken:  Fined $9,000
Violation:  Failed to timely act on a properly completed medical bill; failed to timely pay income benefits to injured employee; failed to pay benefits based on opinion of designated doctor during pendency of dispute


Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-20175154
Date of Order:  7/18/2017
Action Taken:  Fined $32,400
Violation:  Failed to act on a properly completed medical bill; failed to comply with division order; Failed to timely pay income benefits to injured employee


ACE American Insurance Company of Philadelphia, PA
Order Number: DWC-20175132
Date of Order:  6/30/2017
Action Taken:  Fined $1,000
Violation:  Failed to attend a benefit review conference without good cause.


Cromer, Barry Lee M.D. of El Paso
Order Number: DWC-21075109
Date of Order:  6/12/2017
Action Taken:  Fined $3,500; must obtain current MDA Guidelines for two years; must complete medical record documentation course; must complete continuing medical education
Violation:  Failed to consider approved disability guidelines when assessing return to work for injured employee; failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Federal Insurance Company of Warren, NJ
Order Number: DWC-20175133
Date of Order:  6/30/2017
Action Taken:  Fined $22,500
Violation:  Failed to timely pay income benefits to injured employee; failed to accurately notify division of actions taken on a claim


Frank Winston Crum Insurance Company of Clearwater, FL
Order Number: DWC-20175104
Date of Order:  6/8/2017
Action Taken:  Fined $22,000
Violation:  Failed to timely act on a properly completed medical bill; failed to submit accurate medical electronic data interchange records to the division


Frank, Brannon R, M.D. of Austin
Order Number: DWC-20175105
Date of Order:  6/8/2017
Action Taken:  Fined $6,000; must complete continuing medical education
Violation:  Failed to maintain reasonable and efficient utilization and management of chronic pain health care provided to injured employee


Hartford Underwriters Insurance Company of Hartford, CT
Order Number: DWC-21075134
Date of Order:  6/30/2017
Action Taken:  Fined $1,750
Violation:  Failed to timely pay income benefits to injured employee


Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-20175106
Date of Order:  6/8/2017
Action Taken:  Fined $8,750
Violation:  Failed to attend a benefit review conference; failed to timely pay income benefits to injured employee according to designated doctor's report


Liberty Insurance Corporation of Boston, MA
Order Number: DWC-20175135
Date of Order:  6/30/2017
Action Taken:  Fined $13,750
Violation:  Failed to timely pay income benefits to injured employee; failed to timely pay income benefits to injured employee according to designated doctor's report


Milwaukee Casualty Insurance Company of Dallas
Order Number: DWC-20175136
Date of Order:  6/30/2017
Action Taken:  Fined $35,000
Violation:  Failed to timely act on a properly completed medical bill; failed to submit accurate medical electronic data interchange records to division


Protective Insurance Company of Carmel, IN
Order Number: DWC-20175125
Date of Order:  6/27/2017
Action Taken:  Fined $10,000
Violation:  Failed to timely pay income benefits to injured employee; failed to timely and accurately notify division of actions taken on a claim


Technology Insurance Company, Inc of New York, NY
Order Number: DWC-20175126
Date of Order:  6/27/2017
Action Taken:  Fined $35,000
Violation:  Failed to timely act on a properly completed medical bill; failed to submit accurate medical electronic data interchange records to division


Trumbull Insurance Company of Hartford, CT
Order Number: DWC-20175107
Date of Order:  6/8/2017
Action Taken:  Fined $2,500
Violation:  Failed to timely pay income benefits to injured employee


Valley Forge Insurance Company of Chicago, IL
Order Number: DWC-20175127
Date of Order:  6/27/2017
Action Taken:  Fined $8,000
Violation:  Failed to timely pay accrued income benefits to injured employee; failed to timely pay accrued income benefits to injured employee according to designated doctor's report


Wesco Insurance Company of New York, NY
Order Number: DWC-20175128
Date of Order:  6/27/2017
Action Taken:  Fined $35,000
Violation:  Failed to timely act on a properly completed medical bill; failed to submit accurate medical electronic data interchange records to division


Accident Fund Insurance Company of America of Lansing, MI
Order Number: DWC-20175059
Date of Order:  5/3/2017
Action Taken:  Fined $20,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries


Accident Fund Insurance Company of America of Lansing, MI
Order Number: DWC-20175083
Date of Order:  5/19/2017
Action Taken:  Fined $1,000
Violation:  Failed to timely pay income benefits to injured employees


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-20175096
Date of Order:  5/26/2017
Action Taken:  Fined $1,000
Violation:  Failed to attend a benefit review conference without good cause


Flores, Alex Jr., D.C. of Edinburg
Order Number: DWC-20175075
Date of Order:  5/12/2017
Action Taken:  Fined $2,500; must complete medical record documentation training and certified medical education return to work course
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records; failed to consider medical guidelines when assessing return to work


Fuentes, Jose Armando M.D. of Dallas
Order Number: DWC-20175074
Date of Order:  5/12/2017
Action Taken:  Fined $3,500; must complete medical record documentation training and certified medical education return to work course; must purchase and maintain MD Guidelines for two years
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records; failed to consider medical guidelines when assessing return to work; failed to explain why injuries prevented injured employees from returning to work


Illinois National Insurance Company of New York City, NY
Order Number: DWC-20175086
Date of Order:  5/19/2017
Action Taken:  Fined $4,000
Violation:  Failed to pay accurate income benefits to injured employees; failed to pay accurate death benefits to legal beneficiaries; failed to provide accurate claim data to division


National Fire Insurance Company of Hartford of Chicago, IL
Order Number: DWC-20175081
Date of Order:  5/15/2017
Action Taken:  Fined $14,250
Violation:  Failed to pay accurate income benefits to injured employees; failed to pay accurate death benefits to legal beneficiaries; failed to provide accurate claim data to division


National Interstate Insurance Company of Richfield, OH
Order Number: DWC-20175058
Date of Order:  5/3/2017
Action Taken:  Fined $6,000
Violation:  Failed to pay income benefits to injured employees


New Hampshire Insurance Company of New York, NY
Order Number: DWC-20175056
Date of Order:  5/3/2017
Action Taken:  Fined $3,000
Violation:  Failed to timely pay attorney's fees


New Hampshire Insurance Company of New York, NY
Order Number: DWC-20175085
Date of Order:  5/19/2017
Action Taken:  Fined $38,000
Violation:  Failed to pay accurate income benefits to injured employees; failed to pay accurate death benefits to legal beneficiaries; failed to provide accurate claim data to division; failed to timely pay attorney's fees


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