SOUTHWESTERN NEWS ZONE......

Commissioner of Workers’ Compensation Rod Bordelon recently announced final disciplinary actions taken by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) in May 2009. The final actions include orders assessing administrative penalties totaling $33,500 for violations of the Texas Labor Code and rules promulgated by the Commissioner of Workers’ Compensation.

DIVISION OF WORKERS’ COMPENSATION

FINAL DISCIPLINARY ORDERS MAY 2009 (alphabetical order)

City Of Plano
Order No.: DWC-09-0030
Date of Order: May 8, 2009
Action Taken: Fined $2,500
Violation(s): Failure to respond to a TDI-DWC data request in a timely manner.

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Employers Mutual Casualty Company of Des Moines, IA
Order No.: DWC-09-0026
Date of Order: May 1, 2009
Action Taken: Fined $12,500
Violation(s): Failure to pay the reasonable and necessary medical costs of treatments/services requiring preauthorization which were approved prior to providing the health care (three instances); inappropriate retrospective review of the medical necessity of preauthorized treatment or services (three instances).

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Jerry Franz, M.D. of Irving
Order No.: DWC-09-0025
Date of Order: May 1, 2009
Action Taken: Fined $3,500
Violation(s): Failure to file the Report of Medical Evaluation in a timely manner (11 instances); failure to respond to letters of clarification in a timely manner (three instances); failure to timely re-examine claimants after the letter of clarification request.

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Liberty Insurance Corporation of Boston, MA
Order No.: DWC-09-0027
Date of Order: May 1, 2009
Action Taken: Fined $3,750
Violation: Failure to use a doctor licensed in the State of Texas to conduct a peer review requested by the health care provider for medical necessity of health care services provided.

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Old Republic Insurance Company of Greensburg, PA
Order No.: DWC-09-0028
Date of Order: May 1, 2009
Action Taken: Fined $7,500
Violations: Failure to use a doctor licensed in the State of Texas to conduct a peer review requested by the health care provider for medical necessity of health care services provided (two instances).

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Service Lloyds Insurance Company of Austin
Order No.: DWC-09-0029
Date of Order: May 1, 2009
Action Taken: Fined $3,750
Violation: Failure to use a doctor licensed in the State of Texas to conduct a peer review requested by the health care provider for medical necessity of health care services provided.