Texas Workers’ Comp Division Assesses $153K in Fines in June, July

The Texas Department of Insurance Division of Workers’ Compensation (DWC) announced final disciplinary actions taken by Commissioner of Workers’ Compensation Albert Betts during June and July 2007. The final actions include orders assessing administrative penalties totaling $153,427 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.

Final Disciplinary Orders for June-July 2007:

ACE Property & Casualty Ins Co, et al of Philadelphia, PA
Order Number: DWC-07-0037
Date of Order: June 5, 2007
Action Taken: Fined $87,727
Violation(s): Inappropriately processed medical bills; failure to meet the minimum compliance standard of a medical bill process audit.

Alost, Thomas E., M.D. of El Paso
Order Number: DWC-07-0040
Date of Order: June 5, 2007
Action Taken: $3,500 administrative penalty
Violation(s): Failure to timely file and/or appropriately file reports, specifically the Work Status Report, DWC Form-073, failure to meet minimum compliance rates for a DWC Form-073 audit.

American Safety Casualty Insurance Company of Atlanta, GA
Order Number: DWC-07-0064
Date of Order: July 19, 2007
Action Taken: $8,000 administrative penalty
Violation(s): Failure to pay or refund IRO fees; failure to comply with a rule, order or decision of the Commissioner.

Bituminous Casualty Corporation of Rock Island, IL
Order Number: DWC-07-0042
Date of Order: June 5, 2007
Action Taken: $1,200 administrative penalty
Violation(s): Failure to timely process and take action on a medical bill.
City of Dallas
Order Number: DWC-07-0058
Date of Order: July 17, 2007
Action Taken: $5,000 administrative penalty
Violation(s): Failure to pay, reduce, deny or audit HCP claim; failure to take timely final action on a medical bill.

Cumis Insurance Society, Inc. of Madison, WI
Order Number: DWC-07-0056
Date of Order: July 17, 2007
Action Taken: $7,500 administrative penalty
Violation(s): Failure to timely comply with a rule, order, or decision of the Commissioner, specifically a Medical Dispute Resolution order.

Diamond, Howard Gregg M.D. of Richardson, TX
Order Number: DWC-07-0062 – July 19, 2007
Action Taken: $2,500 administrative penalty
Violation(s): Failure to timely file the Report of Medical Evaluation (DWC Form-069); failure to respond to Commissioner’s request for clarification.

Federal Insurance Company of Warren, NJ
Order Number: DWC-07-0054
Date of Order: July 17, 2007
Action Taken: $8,000 administrative penalty
Violation(s): Failure to pay, reduce/deny or audit HCP claim; failure to timely process and take final action on a medical bill; failure to timely take final action on a correctly completed request for reconsideration; failure to pay or refund IRO fees; failure to comply with a rule or decision by the Commissioner.

Florists’ Mutual Insurance Company of Edwardsville, IL
Order Number: DWC-07-0061
Date of Order: July 19, 2007
Action Taken: $5,000 administrative penalty
Violation(s): Failure to timely pay supplemental income benefits.
Gabel, Gerard, M.D. of Houston
Order Number: DWC-07-0041
Date of Order: June 5, 2007
Action Taken: $6,000 administrative penalty
Violation(s): Failure to timely file and/or appropriately file reports, specifically the Work Status

Hernandez, Alvaro, M.D. of El Paso
Order Number: DWC-07-0039
Date of Order: June 5, 2007
Action Taken: $3,000 administrative penalty
Violation(s): Failure to timely file and/or appropriately file reports, specifically the Work Status Report, DWC Form-073, failure to meet minimum compliance rates of a DWC Form-073 audit.

Kinzie, Daniel, M.D. of Midland
Order Number: DWC-07-0055
Date of Order: July 17, 2007
Action Taken: $4,000 administrative penalty
Violation(s): Failure to timely file and/or appropriately file reports, specifically the Work Status Report, DWC Form-073, failure to meet minimum compliance rates for a DWC Form-073 audit.

New Hampshire Insurance Company of Harrisburg, PA
Order Number: DWC-07-0057
Date of Order: July 17, 2007
Action Taken: $1,500 administrative penalty
Violation(s): Failure to reduce, deny, pay or audit HCP claim; failure to take final action on a medical bill.

Old Republic Insurance Company of Greensburg, PA
Order Number: DWC-07-0038
Date of Order: June 5, 2007
Action Taken: $1,000 administrative penalty
Violation(s): Failure to initiate temporary income benefits during the required time period.

Sentry Insurance, A Mutual Company of Stevens Point, WI
Order Number: DWC-07-0063
Date of Order: July 19, 2007
Action Taken: $9,500 administrative penalty
Violation(s): Failure to comply with a contested case hearing decision & order; failure to pay income benefits in a timely manner.

Source: Texas Department of Insurance Division of Workers’ Compensation, www.tdi.state.tx.us