Texas Workers’ Comp Penalties Total Nearly $685K for Aug., Sept.

Final disciplinary actions taken by Texas Commissioner of Workers’ Compensation Albert Betts during August and September 2007 include orders assessing administrative penalties totaling $684,877 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.

According to the Texas Department of Insurance Division of Workers’ Compensation, the final disciplinary orders for August and September 2007, in alphabetical order, are:

American Alternative Insurance Corporation of Princeton, NJ
Order Number: DWC 07-0104
Date of Order: September 28, 2007
Action Taken: Fined $6,000
Violation(s): Improper denial of payment for a medical service that was preauthorized.

American Casualty Company of Reading, PA;
Continental Casualty Company, National Fire Insurance Company, Valley Forge Insurance Company, and Transportation Insurance Company all of Chicago, IL
Order Number: DWC-07-0076
Date of Order: August 23, 2007
Action Taken: Fined $80,000
Violation(s): Non-compliance with Texas Labor Code regarding Supplemental Income Benefits delivery.

American Home Assurance Company of New York, NY
Order Number: DWC-07-0091
Date of Order: September 14, 2007
Action Taken: Fined $33,500
Violation(s): An audit discovered 29 instances in which Temporary Income Benefits were paid late for the time period April 16 – May 31, 2004.

City of San Antonio
Order Number: DWC-07-0092
Date of Order: September 14, 2007
Action Taken: Fined $15,000
Violation(s): An audit discovered numerous violations of the Texas Labor Code related to medical bill processing, reporting of medical bill data and accuracy of reporting data.

Dallas National Insurance Company of Dallas
Order Number: DWC-07-0098
Date of Order: September 28, 2007
Action Taken: Fined $5,000
Violation(s): Failure to timely initiate or file a written refusal to pay benefits with an explanation to the injured employee of their right to request a benefit review conference.

Employers Mutual Casualty Company of Des Moines, IA
Order Number: DWC-07-0103
Date of Order: September 28, 2007
Action Taken: Fined $1,500
Violation(s): Improper denial of payment for a medical service that was preauthorized.

Farmers Insurance Exchange, Truck Insurance Exchange, Mid-Century Insurance Company of Austin, TX
Order Number: DWC-07-0105
Date of Order: September 28, 2007
Action Taken: Fined $60,000
Violation(s): Failure to conduct on-site visits, or provide accident prevention services at least every 12 months to each policyholder.

Liberty Insurance Corporation, Liberty Mutual Insurance Company, Liberty Mutual Fire Insurance Company, Employers Insurance Company of Wausau, Wausau Business Insurance Company of Boston, MA and Wausau, WI
Order Number: DWC-07-0099
Date of Order: September 28, 2007
Action Taken: Fined $50,000
Violation(s): Failure to timely provide information to substantiate the medical necessity of the health care requested; failure to timely pay for services; failure to comply with a Contested Case Hearing Decision & Order; failure to timely comply with a benefit review conference interlocutory order; failure to confirm medical benefits coverage; failure to process claims promptly; failure to pay awarding benefits; unreasonably disputing the reasonableness and necessity of health care; failure to comply with a rule, order or decision of the Commissioner.

Liberty Insurance Corporation, Liberty Mutual Insurance Company, Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC 07-0100
Date of Order: September 28, 2007
Action Taken: Fined $125,000
Violation(s): Wrongful denial of preauthorized medical services.

Liberty Insurance Corporation, Liberty Mutual Insurance Company, Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC 07-0101
Date of Order: September 28, 2007
Action Taken: Fined $175,000
Violation(s): An audit of the companies revealed 694 inappropriately processed preauthorized medical bills for services paid between 1/1/04 and 12/31/04.

Liberty Insurance Corporation, Liberty Mutual Insurance Company, Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC 07-0102
Date of Order: September 28, 2007
Action Taken: Fined $125,000
Violation(s): Wrongful denial of preauthorized medical services.

Phoenix Assurance Company of New York, Connecticut Indemnity Company, Fire & Casualty Insurance Company of Connecticut of Charlotte, NC
Order Number: DWC-07-0075
Date of Order: August 23, 2007
Action Taken: Fined $8,877
Violation(s): Failure to timely pay initial Temporary Income Benefits; failure to comply with a rule, order or decision of the Commissioner.