TX DWC Announces September Workers' Compensation Violations

         On October 20, 2014, Texas's Division of Workers’ Compensation (DWC) announced final disciplinary actions against insurance carriers, health care providers, and employers for violating the state's workers' compensation laws. Division of Workers' Compensation Announces Recent Enforcement Action, Tex. Dep’t Ins. (Oct. 20, 2014), available at http://www.tdi.texas.gov/news/2014/dwc---10---20.html.

           Since January 1, 2014, administrative penalties for these violations total $1,774,345, including $1,658,245 against insurance carriers, $65,600 against health care providers, and $1,000 against employers.

          Texas Labor Code violations cited by the courts include failure to timely pay income benefits, timely pay a medical bill, timely document an injury, and timely file or accurately complete DWC forms, such as reports or records. Below is a summary of DWC final orders in the month of September.

 

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
V

iolation: 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

Texas Injury Statistics by Race Go Uncollected

Access the NY Times article here: http://www.nytimes.com/2014/10/10/us/injury-statistics-by-race-go-uncollected.html?_r=0