Texas Workers’ Comp Div. Issues $169K in Fines in Dec.and Jan.

March 5, 2009

Texas Commissioner of Workers’ Compensation Rod Bordelon announced that disciplinary actions taken by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) in December 2008 and January 2009 resulted in administrative penalties totaling $169,800.

Commissioner’s orders are subject to appeal to state district court within 30 days after being issued.

Final Disciplinary Orders for December 2008 and January 2009:

Ace American Insurance Company of Philadelphia, PA
Order No.: DWC-08-0094
Date of Order: December 19, 2008
Action Taken: Fined $37,500
Violation(s): Failure to use a doctor licensed in the State of Texas to review health care services requested by a health care provider for medical necessity (10 instances).

ACIG Insurance Company of Dallas
Order No.: DWC-09-0010
Date of Order: January 30, 2009
Action Taken: Fined $2,000
Violation(s): Failure to take final action on a medical bill no later than the 45th day following receipt.

American Casualty Company of Reading Pennsylvania of Chicago, IL
Order No.: DWC-09-0001
Date of Order: January 7, 2009
Action Taken: Fined $4,000
Violation(s): Failure to use a doctor licensed in the State of Texas to review health care services requested by a health care provider for medical necessity.

American Home Assurance Company of New York City, NY
Order No.: DWC-09-0005
Date of Order: January 8, 2009
Action Taken: Fined $22,500
Violation(s): Failure to use a doctor licensed in the State of Texas to review health care services requested by a health care provider for medical necessity (six instances).

Fidelity and Guaranty Insurance Company of Saint Paul, MN
Order No.: DWC-09-0007
Date of Order: January 8, 2009
Action Taken: Fined $9,000
Violation(s): Late payment for preauthorized services (five instances); improper denial of partial payment for preauthorized services.

Indemnity Insurance Company of North America of Philadelphia, PA
Order No.: DWC-08-0095
Date of Order: December 19, 2008
Action Taken: Fined $7,500
Violation(s): Failure to use a doctor licensed in the State of Texas to review health care services requested by a health care provider for medical necessity (two instances).

The Insurance Company of the State of Pennsylvania of Harrisburg, PA
Order No.: DWC-09-0004
Date of Order: January 8, 2009
Action Taken: Fined $7,500
Violation(s): Failure to use a doctor licensed in the State of Texas to review health care services requested by a health care provider for medical necessity (two instances).

Charles Murphy, M.D. of Plano
Order No.: DWC-09-0003
Date of Order: January 8, 2009
Action Taken: Fined $45,000
Violation(s): Failure to file the Report of Medical Evaluation in a timely manner (106 instances); failure to file the Report of Medical Evaluation before the seven-day deadline expired (106 instances); and failure to meet the compliance standard of 95 percent.

New Hampshire Insurance Company of Harrisburg, PA
Order No.: DWC-09-0006
Date of Order: January 8, 2009
Action Taken: Fined $7,500
Violation(s): Failure to use a doctor licensed in the State of Texas to review health care services requested by a health care provider for medical necessity (two instances).

Eric Roberson, M.D. of Webster
Order No.: DWC-09-0009
Date of Order: January 30, 2009
Action Taken: Fined $12,300
Violation(s): Failure to file the Report of Medical Evaluation in a timely manner (105 instances); failure to file the Report of Medical Evaluation with the insurance carrier by facsimile or electronic transmission (105 instances); failure to file the Report of Medical Evaluation before the seven-day deadline (105 instances); and failure to meet the compliance standard of 95 percent.

Zurich American Insurance Company of Schaumburg, IL
Order No.: DWC-09-0002
Date of Order: January 7, 2009
Action Taken: Fined $15,000
Violation(s): Failure to use a doctor licensed in the State of Texas to review health care services requested by a health care provider for medical necessity (four instances).

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

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