TX DWC Enforcement Actions For May 2009

                               
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) in May 2009. The final actions include orders assessing administrative penalties totaling $33,500 for violations of the Texas Labor Code and rules promulgated by the Commissioner of Workers' Compensation.

City Of Plano
Order No.: DWC-09-0030
Date of Order: May 8, 2009
Action Taken: Fined $2,500
Violation(s): Failure to respond to a TDI-DWC data request in a timely manner.

Employers Mutual Casualty Company of Des Moines, IA
Order No.: DWC-09-0026
Date of Order: May 1, 2009
Action Taken: Fined $12,500
Violation(s): Failure to pay the reasonable and necessary medical costs of treatments/services requiring preauthorization which were approved prior to providing the health care (three instances); inappropriate retrospective review of the medical necessity of preauthorized treatment or services (three instances).

Jerry Franz, M.D. of Irving
Order No.: DWC-09-0025
Date of Order: May 1, 2009
Action Taken: Fined $3,500
Violation(s): Failure to file the Report of Medical Evaluation in a timely manner (11 instances); failure to respond to letters of clarification in a timely manner (three instances); failure to timely re-examine claimants after the letter of clarification request.

Liberty Insurance Corporation of Boston, MA
Order No.: DWC-09-0027
Date of Order: May 1, 2009
Action Taken: Fined $3,750
Violation: Failure to use a doctor licensed in the State of Texas to conduct a peer review requested by the health care provider for medical necessity of health care services provided.

Old Republic Insurance Company of Greensburg, PA
Order No.: DWC-09-0028
Date of Order: May 1, 2009
Action Taken: Fined $7,500
Violations: Failure to use a doctor licensed in the State of Texas to conduct a peer review requested by the health care provider for medical necessity of health care services provided (two instances).

Service Lloyds Insurance Company of Austin
Order No.: DWC-09-0029
Date of Order: May 1, 2009
Action Taken: Fined $3,750
Violation: Failure to use a doctor licensed in the State of Texas to conduct a peer review requested by the health care provider for medical necessity of health care services provided.

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