TDI Notes Dec., Jan Enforcement Actions

The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) announced final disciplinary actions taken by Commissioner of Workers’ Compensation Albert Betts in December 2007 and January 2008. The final actions include orders assessing administrative penalties totaling $131,000 for violations of the Texas Workers’ Compensation Act. Commissioner’s orders are subject to appeal to state district court within 30 days after being issued.

DIVISION OF WORKERS’ COMPENSATION FINAL DISCIPLINARY ORDERS DECEMBER 2007 & JANUARY 2008 (alphabetical order)

Ace American Insurance Company of Philadelphia, PA
Order No.: DWC-08-0011
Date of Order: January 24, 2008
Action Taken: Fined $21,000
Violation(s): Failure to timely pay temporary income benefits; failure to timely take action on a properly completed medical bill (12 instances); failure to take final action on a correctly completed request for reconsideration; failure to pay for the reasonable and necessary medical costs after carrier gave preauthorization; inappropriate denial of a medical bill.

Ace Fire Underwriter's Insurance Company of Philadelphia, PA
Order No.: DWC-08-0013
Date of Order: January 24, 2008
Action Taken: Fined $8,000
Violation(s): Failure to take timely action in response to a medical bill (3 instances); failure to properly deny a medical bill.

American Insurance Company of Novato, CA
Order No.: DWC-08-0006
Date of Order: January 14, 2008
Action Taken: Fined $3,000
Violation(s): Failure to timely comply with a Medical Dispute Resolution Order

American Zurich Insurance Company of Schaumberg, IL
Order No.: DWC-08-0003
Date of Order: January 14, 2008
Action Taken: Fined $5,700
Violation(s): Failure to timely respond to a request for reconsideration; failure to timely comply with an order to pay attorney fees.

Anil T. Bangale, MD of Fort Worth
Order No.: DWC 07-0142
Date of Order: December 7, 2007
Action Taken: Fined $3,000
Violation(s): Failure to timely file a Report of Medical Evaluation with the carrier or carrier's agent.

City of Dallas
Order No: DWC 08-0002
Date of Order: January 9, 2008
Action Taken: Fined $50,000
Violation(s): Numerous violations were found in a medical bill processing audit for failure to timely process and take final action on medical bills; failure to timely and accurately submit information electronically in the form and manner prescribed by the Division; failure to meet the 95 percent compliance standard in some categories.

Indemnity Insurance Company of North America of Philadelphia, PA
Order No.: DWC-08-0014
Date of Order: January 31, 2008
Action Taken: Fined $8,000
Violation(s): Failure to timely take action on a properly completed medical bill (2 instances); failure to take final action on a correctly completed request for reconsideration; late payment on a medical dispute resolution order.

Pacific Employer's Insurance Company of Philadelphia, PA
Order No.: DWC-08-0012
Date of Order: January 24, 2008
Action Taken: Fined $18,000
Violation(s): Failure to pay an advance payment of income benefits ordered by the Division; failure to timely take action on a properly completed medical bill.

Universal Underwriter's Insurance Company of Schaumberg, IL
Order No.: DWC-08-0004
Date of Order: January 14, 2008
Action Taken: Fined $1,500
Violation(s): Failure to timely pay or deny a medical bill.

Zurich American Insurance Company of Schaumberg, IL
Order No.: DWC-08-0005
Date of Order: January 14, 2008
Action Taken: Fined $12,800
Violation(s): Failure to timely comply with a Medical Dispute Resolution Order; failure to timely respond to a request for reconsideration (two instances).