TX DWC Announces Recent Enforcement Actions

Austin, TX (CompNewsNetwork) - Commissioner of Workers' Compensation Rod Bordelon recently announced final disciplinary actions taken by the Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC). The final actions include orders related to violations of the Texas Labor Code and rules promulgated by the Commissioner of Workers' Compensation.  Commissioner's orders are subject to appeal to state district court within 30 days after being issued.

DIVISION OF WORKERS' COMPENSATION

FINAL DISCIPLINARY ORDERS FOR MAY THROUGH JULY 2010 (alphabetical order)

American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-10-0035
Date of Order:  6/4/2010
Order Final In:   June
Action Taken:  Fined $30,000
Violation:  Failed to pay for preauthorized medical services; Failed to comply with TDI-DWC or Commissioner Order (four instances); Failed to timely process medical bills; Failed to submit accurate data to TDI-DWC (10 instances)

Clogston, Curtis M.D. of San Marcos
Order Number: DWC-10-0039
Date of Order:  6/16/2010
Order Final In:   June
Action Taken:  Fined $8,000; Must provide copy of compliance plan; Must complete training
Violation:  Failed to timely file the DWC Form-69 with insurance carrier (62 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic submission (62) instances; Failed to timely file letter of clarification; Refused four or more designated doctor appointments in 90 days

Daniels, Michael M.D. of Arlington
Order Number: DWC-10-0046
Date of Order:  7/5/2010
Order Final In:   July
Action Taken:  Fined $2,500; Must complete training
Violation:  Failed to timely file DWC Form-69 with insurance carrier; Failed to file DWC Form-69 with the carrier via facsimile or electronic submission

Dolgencorp of Texas, Inc. of Goodlettsville, TN
Order Number: DWC-10-0041
Date of Order:  6/30/2010
Order Final In:   June
Action Taken:  Fined $32,000
Violation:  Failed to notify injured worker of actions taken on claim; Failed to begin to pay benefits as required or timely file notice of denial of compensability; Failed to timely initiate TIBs; Failed to take timely action on medical bill; Failed to accurately submit medical bill and payment data to TDI-DWC

Drazner, Bryan M.D. of Dallas
Order Number: DWC10-0034
Date of Order:  5/10/2010
Order Final In:   May
Action Taken:  Fined $15,000; Suspended from Designated Doctor List for six months
Violation:  Failed to timely file DWC Form-69 with insurance carrier (72 instances); Failed to provide documentation proving filing of DWC Form-69 (40 instances); Failed to timely file letter of clarification

Driver Pipeline Company, Inc. of Irving
Order Number: DWC-10-0051
Date of Order:  7/22/2010
Order Final In:   July
Action Taken:  Fined $12,000
Violation:  Failed to timely pay benefits ordered by TDI-DWC

Federal Insurance Company of Warren, NJ
Order Number: DWC-10-0043
Date of Order:  6/30/2010
Order Final In:   June
Action Taken:  Fined $30,000; Must submit compliance plan
Violation:  Improper denial of payment for preauthorized medical services (two instances); Failed to timely act on medical bills; Failed to timely pay TIBs in accordance with Designated Doctor's report; Failed to timely pay for services deemed necessary in Independent Review Organization decision.

Hartford Casualty Insurance Company of Hartford, CT

Order Number: DWC-10-0044

Hartford Casualty Insurance Company of Hartford, CT
Order Number: DWC-10-0044
Date of Order:  6/30/2010
Order Final In:   June
Action Taken:  Fined $42,000
Violation:  Failed to pay for preauthorized medical services; Failed to timely respond to a request for preauthorization; Failed to provide sufficient explanation for denial of payment for medical services; Failed to timely initiate TIBs (30 instances); Failed to submit accurate data to TDI-DWC (78 instances)

Hartford Insurance Company of the Midwest of Hartford, CTOrder Number: DWC10-0045
Date of Order:  6/30/2010
Order Final In:   June
Action Taken:  Fined $50,000
Violation:  Failed to notify TDI-DWC and injured employee of actions taken on claim; Filed to timely pay benefits or file notice of denial; Failed to timely initiate payment of TIBs; Failed to timely act on properly completed medical bill; Failed to pay for preauthorized medical services; Failed to accurately submit medical bill and payment data to TDI-DWC

Jafarnia, Kourosh Korsh M.D. of Houston
Order Number: DWC-10-0052
Date of Order:  7/22/2010
Order Final In:   July
Action Taken:  Must not reapply for authorization to certify maximum medical improvement and assign impairment ratings for one year
Violation:  Failed to timely file DWC Form-69 with insurance carrier (18 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic transmission (23 instances)

Netherlands Insurance Company of Boston, MA
Order Number: DWC-10-0037
Date of Order:  6/4/2010
Order Final In:   June
Action Taken:  Fined $6,000
Violation:  Failed to comply with TDI-DWC ordered advance within seven days of receipt of order

Ninala, Ranil M.D. of Dallas
Order Number: DWC-10-0033
Date of Order:  5/10/2010
Order Final In:   May
Action Taken:  Fined $6,000
Violation:  Failed to timely file DWC Form-69 with insurance carrier (26 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic transmission (14 instances);

Onabajo, Catherine Eno Okpon M.D. of Lewisville
Order Number: DWC-10-0032
Date of Order:  5/10/2010
Order Final In:   May
Action Taken:  Fined $1,000; Suspended from Designated Doctor List for six months;
Violation:  Failed to timely reschedule Designated Doctor appointment; Failed to timely notify injured employee of rescheduled appointment; Failed to timely file narrative report with insurance carrier; Failed to timely file DWC Form-69 with the TDI-DWC (23 instances); Failed to timely file letter of clarification (seven instances)

The Travelers Indemnity Company of Connecticut of Hartford, CT
Order Number: DWC10-0040
Date of Order:  6/24/2010
Order Final In:   June
Action Taken:  Fined $250,000
Violation:  Failed to timely forward Independent Review Organization requests to TDI

Toledo, Luiz M.D. of Fort Worth
Order Number: DWC-10-0038
Date of Order:  6/16/2010
Order Final In:   June
Action Taken:  Fined $5,000; Provide copy of compliance plan; Must complete training
Violation:  Failed to timely file DWC Form-69 with insurance carrier (91 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic submission

Vredenburgh, Jesse W. D.O. of Portland
Order Number: DWC-10-0042
Date of Order:  6/30/2010
Order Final In:   June
Action Taken:  Fined $5,000; Must limit locations for designated doctor examinations for one year; Must complete training
Violation:  Failed to timely reexamine injured employee; Failed to timely file DWC Form-69 with TDI-DWC (101) instances; Failed to timely file letter of clarification (six instances)

Weeks, Trenton M.D. of Flower Mound

Order Number: DWC-10-0036
Date of Order:  6/4/2010
Order Final In:   June
Action Taken:  Fined $5,000; Suspended from Designated Doctor List for three months
Violation:  Failed to timely file DWC Form-69 with insurance carrier (37 instances); Failed to file DWC Form-69 with the carrier via facsimile or electronic submission (41 instances)

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