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.
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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