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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.

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


Old Republic Insurance Company of Chicago, IL
Order Number: DWC-20175084
Date of Order:  5/19/2017
Action Taken:  Fined $11,000
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


Security National Insurance Company of Dallas
Order Number: DWC-20175076
Date of Order:  5/12/2017
Action Taken:  Fined $3,000
Violation:  Failed to timely pay income benefits according to interlocutory order


Technology Insurance Company Inc. of New York, NY
Order Number: DWC-20175097
Date of Order:  5/26/2017
Action Taken:  Fined $29,000
Violation:  Failed to timely pay income benefits to injured employees; failed to timely report initiation of income benefits to the division; failed to accurately notify the division of actions taken on a claim


The Insurance Company of the State of Pennsylvania of New York, NY
Order Number: DWC-20175057
Date of Order:  5/3/2017
Action Taken:  Fined $7,500
Violation:  Failed to timely act on a properly completed medical bill


Travelers Casualty & Surety Company of Hartford, CT
Order Number: DWC-20175078
Date of Order:  5/12/2017
Action Taken:  Fined $13,000
Violation:  Failed to timely pay income benefits to injured employees; failed to timely report initiation of income benefits to division; failed to accurately notify division and injured employee of actions taken on a claim


Travelers Casualty Insurance Company of America of Hartford, CT
Order Number: DWC-20175077
Date of Order:  5/12/2017
Action Taken:  Fined $3,000
Violation:  Failed to timely pay income benefits to injured employees


Woywood, Roger Brian D.C. of Austin
Order Number: DWC-20175060
Date of Order:  5/3/2017
Action Taken:  Fined $1,500
Violation:  Failed to timely contact injured employee about change in schedule for designated doctor exam; failed to attend an ordered designated doctor exam


ACE American Insurance Company of Philadelphia, PA
Order Number: DWC-20175049
Date of Order:  4/27/2017
Action Taken:  Fined $1,000
Violation:  Failed to attend a benefit review conference without good cause


Arredondo, Eradio M.D. of Austin
Order Number: DWC-20175025
Date of Order:  4/12/2017
Action Taken:  Fined $1,000
Violation:  Failed to notify division of disqualifying association for designated doctor examination


Starr Indemnity & Liability Company of New York City, NY
Order Number: DWC-20175020
Date of Order:  4/5/2017
Action Taken:  Fined $1,000
Violation:  Failed to timely dispute entitlement to death benefits


Wausau Underwriters Insurance Company of Boston, MA
Order Number: DWC-20175050
Date of Order:  4/27/2017
Action Taken:  Fined $40,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries; failed to timely notify division of termination of death benefits


Wesco Insurance Company of New York, NY
Order Number: DWC-20175051
Date of Order:  4/27/2017
Action Taken:  Fined $2,500
Violation:  Failed to timely pay income benefits to injured employee


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