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

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