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Texas Division of Workers’ Compensation Announces Enforcement Actions For December, 2007 And January, 2008
28 Feb, 2008 WorkersCompensation.com
Austin, TX (CompNewsNetwork) - The Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) today announced final disciplinary actions taken by Commissioner of Workers' Compensation Albert Betts in December 2007 and January 2008. The final actions include orders assessing administrative penalties totaling $131,000 for violations of the Texas Workers’ Compensation Act. Commissioner’s orders are subject to appeal to state district court within 30 days after being issued.
Copies of Commissioner of Workers' Compensation orders may be obtained by calling Victoria Ortega, TDI-DWC Legal Services, at 512-804-4715 or via e-mail to Victoria.Ortega@tdi.state.tx.us.
DIVISION OF WORKERS’ COMPENSATION FINAL DISCIPLINARY ORDERS DECEMBER 2007 & JANUARY 2008 (alphabetical order)
Ace American Insurance Company of Philadelphia, PA
Order No.: DWC-08-0011
Date of
Order: January 24, 2008
Action Taken: Fined $21,000
Violation(s): Failure to timely
pay temporary income benefits; failure to timely take action on a properly completed
medical bill (12 instances); failure to take final action on a correctly completed request
for reconsideration; failure to pay for the reasonable and necessary medical costs after
carrier gave preauthorization; inappropriate denial of a medical bill.
Ace
Fire Underwriter's Insurance Company of Philadelphia, PA
Order No.: DWC-08-0013
Date
of Order: January 24, 2008
Action Taken: Fined $8,000
Violation(s): Failure to take
timely action in response to a medical bill (3 instances); failure to properly deny a
medical bill.
American Insurance Company of Novato, CA
Order No.:
DWC-08-0006
Date of Order: January 14, 2008
Action Taken: Fined
$3,000
Violation(s): Failure to timely comply with a Medical Dispute Resolution
Order
American Zurich Insurance Company of Schaumberg, IL
Order No.:
DWC-08-0003
Date of Order: January 14, 2008
Action Taken: Fined $5,700
Violation(s): Failure to timely respond to a request for reconsideration; failure to
timely comply with an order to pay attorney fees.
Anil T. Bangale, MD of Fort
Worth
Order No.: DWC 07-0142
Date of Order: December 7, 2007
Action Taken: Fined
$3,000
Violation(s): Failure to timely file a Report of Medical Evaluation with the
carrier or carrier's agent.
City of Dallas
Order No: DWC 08-0002
Date
of Order: January 9, 2008
Action Taken: Fined $50,000
Violation(s): Numerous
violations were found in a medical bill processing audit for failure to timely process and
take final action on medical bills; failure to timely and accurately submit information
electronically in the form and manner prescribed by the Division; failure to meet the 95
percent compliance standard in some categories.
Indemnity Insurance Company of
North America of Philadelphia, PA
Order No.: DWC-08-0014
Date of Order: January 31,
2008
Action Taken: Fined $8,000
Violation(s): Failure to timely take action on a
properly completed medical bill (2 instances); failure to take final action on a correctly
completed request for reconsideration; late payment on a medical dispute resolution
order.
Pacific Employer's Insurance Company of Philadelphia, PA
Order No.:
DWC-08-0012
Date of Order: January 24, 2008
Action Taken: Fined
$18,000
Violation(s): Failure to pay an advance payment of income benefits ordered by
the Division; failure to timely take action on a properly completed medical
bill.
Universal Underwriter's Insurance Company of Schaumberg, IL
Order
No.: DWC-08-0004
Date of Order: January 14, 2008
Action Taken: Fined
$1,500
Violation(s): Failure to timely pay or deny a medical bill.
Zurich
American Insurance Company of Schaumberg, IL
Order No.: DWC-08-0005
Date of Order:
January 14, 2008
Action Taken: Fined $12,800
Violation(s): Failure to timely comply
with a Medical Dispute Resolution Order; failure to timely respond to a request for
reconsideration (two instances).
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