Texas Work Comp Enforcements Include Suspensions, Insurer Fines

Final disciplinary actions taken in March and April by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) include removal of providers from Designated Doctors list and insurance company fines.

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

Division Of Workers’ Compensation Final Disciplinary Orders for March and April 2010 (alphabetical order)

Albrand, Otmar M.D. of Austin
Order Number: DWC-10-0028
Date of Order: 4/30/2010
Order Final In: April
Action Taken: Fined $10,000; Must implement compliance plans submitted to the TDI-DWC.
Violation: Failed to timely file letter of clarification (two instances); Failed to timely file DWC Form-069 with the TDI-DWC (four instances); Failed to timely notify injured employee of appointment changes; Failed to timely conduct re-examination pursuant to letter of clarification request.

Arrowood Indemnity Company of Charlotte, NC
Order Number: DWC-10-0017
Date of Order: 3/9/2010
Order Final In: March
Action Taken: Fined $6,000.
Violation: Failed to respond to a TDI-DWC request for information (three instances).

Driggers, Kimberley D.C. of New Braunfels
Order Number: DWC-10-0026
Date of Order: 4/30/2010
Order Final In: April
Action Taken: Cease and desist from practicing before the TDI-DWC as health care practitioner for 10 years.
Violation: Failed to timely file required medical records; Failed to timely comply with TDI-DWC order to produce medical records.

Frazier, M. Lewis Jr., M.D. of Plano
Order Number: DWC-10-0027
Date of Order: 4/30/2010
Order Final In: April
Action Taken: Fined $5,000; Suspended from Designated Doctor List for six months; Must complete existing designated doctor assignments; Must timely respond to TDI-DWC requests for letters of clarification; Must submit a compliance plan to TDI-DWC.
Violation: Failed to timely file the DWC Form-069 with the TDI-DWC (five instances).

Garrison, Christopher M.D. of Austin
Order Number: DWC-10-0022
Date of Order: 3/22/2010
Order Final In: March
Action Taken: Suspended from Designated Doctor List for 90 days; Must complete scheduled appointments and examinations; Must not modify appointment location matrix for 90 days; Must provide compliance plan to TDI-DWC.
Violation: Failed to timely file letter of clarification; Failed to timely file DWC Form-069 with insurance carrier (10 instances); Failed to file DWC Form-069 with the insurance carrier via facsimile or electronic transmission (three instances).

Lindsey, William H. M.D. of Denton
Order Number: DWC-10-0016
Date of Order: 3/9/2010
Order Final In: March
Action Taken: Removed from Designated Doctor List; Prohibited from practicing as designated doctor or certifying doctor.
Violation: Failed to file a letter of clarification in a timely manner (two instances); Failed to timely conduct an examination after a cancelled appointment; Failed to timely file DWC Form-069 with the TDI-DWC (two instances).

Morse, Jack A. M.D. of Denton
Order Number: DWC-10-0019
Date of Order: 3/22/2010
Order Final In: March
Action Taken: Must not reapply for admission to Designated Doctor List for one year.
Violation: Failed to timely file letter of clarification (three instances); Failed to timely file DWC Form-069 with the insurance carrier (10 instances); Failed to timely notify TDI-DWC of rescheduled designated doctor appointment; Failed to schedule or perform four designated doctor appointments within 90 days.

Neel, Richard L. M.D. of San Antonio
Order Number: DWC-10-0030
Date of Order: 4/30/2010
Order Final In: April
Action Taken: Fined $30,000; Must provide compliance plan to TDI-DWC.
Violation: Failed to timely file the DWC Form-069 with the TDI-DWC (94 instances); Failed to file the DWC Form-069 with the insurance carrier via facsimile or electronic transmission (88 instances).

Oakes, Walter H. M.D. of Galveston
Order Number: DWC-10-0029
Date of Order: 4/30/2010
Order Final In: April
Action Taken: Fined $6,500; Must maintain proper records/documentation and follow compliance plan.
Violation: Failed to timely file the DWC Form-069 with the insurance carrier (23 instances); Failed to file DWC Form-069 with the insurance carrier via facsimile or electronic transmission (23 instances).

Parks, Lawrence D.C. of League City
Order Number: DWC-10-0021
Date of Order: 3/22/2010
Order Final In: March
Action Taken: Fined $2,500; Must maintain proper records/documentation and follow compliance plan.
Violation: Failed to timely file DWC Form-069 with the insurance carrier (14 instances); Failed to file DWC Form-069 with the insurance carrier via facsimile or electronic transmission (14 instances).

Service Lloyds Insurance Company of Austin
Order Number: DWC-10-0031
Date of Order: 4/30/2010
Order Final In: April
Action Taken: Fined $10,000.
Violation: Failed to pay reasonable and necessary medical costs relating to treatments/services which were preauthorized; Failed to sufficiently explain reason for reduction or denial of payment for health services provided to injured employee.

Texas Mutual Insurance Company of Austin
Order Number: DWC-10-0020
Date of Order: 3/22/2010
Order Final In: March
Action Taken: Fined $24,000.
Violation: Failed to use a doctor licensed in Texas to review medical necessity of health care services requested by health care provider (six instances).

Varela, Humberto M.D. of Laredo
Order Number: DWC-10-023
Date of Order: 3/23/2010
Order Final In: March
Action Taken: Suspended from Designated Doctor List for 18 months; Must complete existing appointments and examinations and respond to TDI-DWC requests for letters of clarification; Must not modify appointment location matrix.
Violation: Failed to timely file the DWC Form-069 with the insurance carrier (44 instances); Failed to file the DWC Form-069 with the insurance carrier via facsimile or electronic transmission (50 instances).

Source: TDI