Texas Dept. Takes Actions Against Insurers

The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) announced final disciplinary actions taken by Commissioner of Workers’ Compensation Albert Betts in February and March 2008. The final actions include orders assessing administrative penalties totaling $63,800 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.

Copies of Commissioner of Workers' Compensation orders may be obtained by calling Victoria Ortega, TDI-DWC Legal Services, at 512-804-4715 or via e-mail to Victoria.Ortega@tdi.state.tx.us.

DIVISION OF WORKERS’ COMPENSATION
FINAL DISCIPLINARY ORDERS FEBRUARY AND MARCH 2008 (alphabetical order)

American Zurich Insurance Company of Schaumburg, IL
Order No.: DWC-08-0034
Date of Order: March 31, 2008
Action Taken: Fined $20,000
Violation(s): Failure to comply with an order or decision of the commissioner to issue interest due; failure to timely pay, reduce, deny or determine to audit a health care provider’s bill; failure to timely process and take final action on a properly completed request for reconsideration of a medical bill the carrier previously acted on within 21 days of receipt (three instances); failure to timely pay, reduce or deny a medical bill (two instances); failure to pay for medical services which were preauthorized.

Brownsville Independent School District of Brownsville
Order No.: DWC 08-0021
Date of Order: February 29, 2008
Action Taken: Fined $5,000
Violation(s): Failure to timely process a medical bill (two instances); failure to take final action on a correctly completed request for reconsideration of a medical bill.

Deep East Texas Self Insurance Fund of Jasper
Order No.: DWC-08-0028
Date of Order: March 20, 2008
Action Taken: Fined $2,000
Violation(s): Failure to timely refund an IRO fee upon receipt of an order from the Division regardless of whether an appeal had been filed.

Dolgencorp of Texas, Inc., of Goodlettsville, TN
Order No.: DWC-08-0031
Date of Order: March 31, 2008
Action Taken: Fined $9,000
Violation(s): Failure to give sufficient explanation for a reduction or denial of a medical bill; failure to timely take final action on a medical bill after the carrier received the complete medical bill; failure to take final action on a properly completed request for reconsideration of a medical bill within 21 days of receipt.

Fort Worth ISD of Fort Worth
Order No.: DWC-08-0024
Date of Order: March 19, 2008
Action Taken: Fined $7,800
Violation(s): Failure to timely refund an IRO fee upon receipt of an order from the commission regardless of whether an appeal had been filed.

Uma R. Gullapalli, M.D., of Victoria
Order No.: DWC-08-0025
Date of Order: March 19, 2008
Action Taken: Fined $4,000
Violation(s): Untimely or inappropriate filing of TWCC-69's in numerous cases discovered in an audit.

Lumbermen's Underwriting Alliance of Boca Raton, FL
Order No.: DWC-08-0033
Date of Order: March 31, 2008
Action Taken: Fined $4,000
Violation(s): Failure to timely pay, reduce, deny or determine to audit a HCP's claim; denial of a medical bill for an inappropriate reason.

Universal Underwriters of Texas Insurance Company of Overland Park, KS
Order No.: DWC-08-0032
Date of Order: March 31, 2008
Action Taken: Fined $12,000
Violation(s): Failure to comply with a decision of a hearing officer during the pendency of an appeal to the appeals panel.