Texas Workers’ Comp August Enforcements: $500K in Fines

Final disciplinary actions taken by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) in August 2009 resulted in administrative penalties totaling $503,300. The majority of that amount is represented by fines against two insurers: American Home Assurance Company and Zurich American Insurance Company.

Commissioner of Workers’ Compensation Rod Bordelon’s orders are subject to appeal to state district court within 30 days after being issued.

Final disciplinary actions for August 2009:

American Home Assurance Company of Chicago, IL
Order Number: DWC-09-0053
Date of Order: 8/28/2009
Order Final In: August
Action Taken: Fined $48,000
Violation: Failure to timely comply with a TDI-DWC decision or order (two instances); Failure to take final action on a complete medical bill (four instances); failure to pay for preauthorized medical services (three instances); failure to timely respond to request for reconsideration.

American Home Assurance Company of Chicago, IL
Order Number: DWC-09-0054
Date of Order: 8/28/2009
Order Final In: August
Action Taken: Fined $51,500
Violation: Failure to timely comply with a TDI-DWC decision or order (two instances); failure to pay a complete medical bill within 45 days of receipt (two instances); failure to pay for medical services that had been preauthorized (four instances).

American Home Assurance Company of Chicago, IL
Order Number: DWC-09-0055
Date of Order: 8/28/2009
Order Final In: August
Action Taken: Fined $48,000
Violation: Failure to timely comply with a TDI-DWC decision or order; failure to take final action on a medical bill within 45 days of receipt (four instances); failure to pay for medical services that were preauthorized (three instances).

American Home Assurance Company of Chicago, IL
Order Number: DWC-09-0056
Date of Order: 8/28/2009
Order Final In: August
Action Taken: Fined $52,500
Violation: Failure to timely comply with a TDI-DWC decision or order (two instances); failure to timely pay a complete medical bill within 45 days of receipt (six instances); failure to pay for medical services that had been preauthorized (two instances); failure to respond to a request for reconsideration within 21 days of receipt.

Tarrant County Hospital District of Fort Worth
Order Number: DWC-09-0051
Date of Order: 8/25/2009
Order Final In: August
Action Taken: Fined $3,500
Violation: Failure to timely respond to a request for data.

Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0043
Date of Order: 8/25/2009
Order Final In: August
Action Taken: Fined $42,750
Violation: Improper denial of payment for medical services that were preauthorized (six instances).

Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0044
Date of Order: 8/25/2009
Order Final In: August
Action Taken: Fined $55,500
Violation: Improper denial of payment for medical services that were preauthorized (10 instances).

Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0045
Date of Order: 8/25/2009
Order Final In: August
Action Taken: Fined $59,500
Violation: Improper denial of payment for medical services that were preauthorized (eight instances).

Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0046
Date of Order: 8/25/2009
Order Final In: August
Action Taken: Fined $32,500
Violation: Failure to timely pay a TDI-DWC or Commissioner order (five instances).

Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0047
Date of Order: 8/25/2009
Order Final In: August
Action Taken: Fined $30,000
Violation: Failure to timely pay a TDI-DWC or Commissioner order (five instances).

Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0048
Date of Order: 8/25/2009
Order Final In: August
Action Taken: Fined $19,750
Violation: Failure to timely pay a TDI-DWC or Commissioner order (two instances).

Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0049
Date of Order: 8/25/2009
Order Final In: August
Action Taken: Fined $23,800
Violation: Failure to timely pay TDI-DWC or Commissioner order (three instances); failure to timely pay Temporary Income Benefits (TIBs) (three instances).

Zurich American Insurance Company of Schaumberg, IL
Order Number: DWC-09-0050
Date of Order: 8/25/2009
Order Final In: August
Action Taken: Fined $36,000
Violation: Failure to take action on medical bills within 45 days of receipt (10 instances); failure to timely respond to a request for preauthorization; failure to timely respond to a Request for Reconsideration; failure to sufficiently explain reason for denying or reducing payment on a medical bill (eight instances).

Source: Texas Department of Insurance, Division of Workers’ Compensation