Texas Work Comp October Enforcement Actions Include Hefty Fines

Final disciplinary actions taken by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) in October include fines of up to $153,000, the department announced. Commissioner of Workers’ Compensation Rod Bordelon’s orders are subject to appeal to state district court within 30 days after being issued.

Final Disciplinary Orders for October 2010

Arch Insurance Company of Jersey City, NJ
Order Number: DWC10-0092
Date of Order: 10/22/2010
Order Final In: October
Action Taken: Fined $14,000
Violation: Failed to properly file notice when reduced or denied payment or services; Failed to timely pay or dispute initial temporary income benefits payment within 15 days of notice of injury; Failed to timely process and take final action on a correctly completed request for reconsideration on a medical bill within 21 days

Hood, James F. M.D. of Houston
Order Number: DWC10-0090
Date of Order: 10/19/2010
Order Final In: October
Action Taken: Fined $10,000; Must attend Division educational conference on roles and responsibilities of health care providers
Violation: Failed to file the DWC Form-69 in a timely manner; Failed to submit DWC Form-69 to the insurance carrier via facsimile or electronic transmission; Failed to timely respond to a letter of clarification; Refused four Designated Doctor appointments within 90 days

Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC10-0088
Date of Order: 10/8/2010
Order Final In: October
Action Taken: Fined $50,000
Violation: Failed to timely process and take final action on a correctly completed request for reconsideration on a medical bill within 21 days; Failed to sufficiently explain reason for denial or reduction of payment on medical bill; Failed to pay for preauthorized medical services; Failed to take final action on medical bill no later than 45th day after received completed bill; Failed to timely pay temporary income benefits to injured employee

Liberty Mutual Insurance Company of Boston, MA
Order Number: DWC10-0085
Date of Order: 10/8/2010
Order Final In: October
Action Taken: Fined $17,000
Violation: Failed to accept communication in absence of DWC Form-001 as notice of injury and failed to contact employer within seven days of notification; Failed to timely pay supplemental income benefits; Failed to timely pay Division order or Commissioner order; Failed to solicit request for safety information or assistance from policyholder

Liberty Insurance Corporation of Boston, MA
Order Number: DWC10-0087
Date of Order: 10/8/2010
Order Final In: October
Action Taken: Fined $153,000
Violation: Failed to timely pay for preauthorized medical services; Failed to timely process and take final action on a correctly completed request for reconsideration on a medical bill within 21 days; Failed to sufficiently explain reason for denying or reducing payment on a medical bill; Failed to pay temporary income benefits to injured employee; Failed to timely pay impairment income benefits; Failed to take final action on medical bill no later than 45th day after received completed bill

LM Insurance Corporation of Boston, MA
Order Number: DWC10-00086
Date of Order: 10/8/2010
Order Final In: October
Action Taken: Fined $30,000
Violation: Improperly denied payment for preauthorized medical services; Failed to timely process and take final action on a correctly completed request for reconsideration on a medical bill within 21 days; Failed to sufficiently explain denial or reduction of payment on a medical bill; Failed to pay temporary income benefits to an injured employee

Massenburg, Bryan M.D. of Longview
Order Number: DWC10-0089
Date of Order: 10/8/2010
Order Final In: October
Action Taken: Fined $12,000; Must attend Division educational course on roles and responsibilities of health care providers;
Violation: Failed to timely file DWC Form-69 with the insurance carrier (92 instances); Failed to file the DWC Form-69 with carrier via facsimile or electronic transmission (92 instances)

Southern Vanguard Insurance Company of Dallas
Order Number: DWC10-0091
Date of Order: 10/19/2010
Order Final In: October
Action Taken: Fined $15,000
Violation: Failed to initiate payment of temporary income benefits or file a notice of refusal; Inaccurately reported to the Division actions taken on a claim; Failed to timely process and take final action on a correctly completed request for reconsideration on a medical bill within 21 days

West Houston Radiology Associates of Houston
Order Number: DWC100093
Date of Order: 10/22/2010
Order Final In: October
Action Taken: Fined $2,500
Violation: Billed injured employee for medical treatments or services when carrier not relieved of liability for costs of health care and injured employee did not violate Labor Code

Source: TDI-DWC