City of Plano of Plano
Order Number: DWC-09-0030
Date of Order:  5/8/2009
Order Final In:   May
Action Taken:  $2,500 Administrative Penalty
Violation:  Failure to respond to a TDI-DWC data request in a timely manner.

Employers Mutual Casualty Company of Des Moines, IA
Order Number: DWC-09-0026
Date of Order:  5/1/2009
Order Final In:   May
Action Taken:  $12,500 Administrative Penalty
Violation:  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).

Franz, Jerry Dr. of Irving, TX
Order Number: DWC-09-0025
Date of Order:  5/1/2009
Order Final In:   May
Action Taken:  $3,500 Administrative Penalty
Violation:  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.

Liberty Insurance Corporation of Boston, MA
Order Number: DWC-09-0027
Date of Order:  5/1/2009
Order Final In:   May
Action Taken:  $3,750 Administrative Penalty
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.

Old Republic Insurance Company of Greensburg, PA
Order Number: DWC-09-0028
Date of Order:  5/1/2009
Order Final In:   May
Action Taken:  $7,500 Administrative Penalty
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 (two instances).

Service Lloyds Insurance Company of Austin, TX
Order Number: DWC-09-0029
Date of Order:  5/1/2009
Order Final In:   May
Action Taken:  $3,750 Administrative Penalty
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.

Metiscan Corpus Christi of Dallas
Order Number: DWC-09-0022
Date of Order:  4/13/2009
Order Final In:   April
Action Taken:  $1,000 Administrative Penalty and Agreed Cease & Desist Order
Violation:  Misuse of the Texas Department of Insurance/Division of Worker’s Compensation name and/or symbol in 19 documents.

Panzarella, Robert Dr. of Humble
Order Number: DWC-09-0024
Date of Order:  4/16/2009
Order Final In:   April
Action Taken:  $12,500 Administrative Penalty
Violation:  Failure to file the Report of Medical Evaluation in a timely manner (97 instances); failure to file the Report of Medical Evaluation with the insurance carrier by facsimile or electronic transmission (11 instances); failure to respond to letters of clarification in a timely manner (six instances); failure to notify TDI-DWC of rescheduled designated doctor examination (four instances); failure to meet compliance standard of 95 percent.

Zurich American Insurance Company of Schaumberg, IL
Order Number: DWC-09-0021
Date of Order:  4/13/2009
Order Final In:   April
Action Taken:  $1,600 Administrative Penalty
Violation:  Failure to initiate Temporary Income Benefits in a timely manner (three instances).

Gill, Darshan Dr. of McAllen
Order Number: DWC-09-0020
Date of Order:  3/20/2009
Order Final In:   March
Action Taken:  $2,000 Administrative Penalty
Violation:  Failure to respond to letters of clarification in a timely manner (two instances).

Otto, Laurie Dr. of Plano
Order Number: DWC-09-0018
Date of Order:  3/19/2009
Order Final In:   March
Action Taken:  $3,750 Administrative Penalty
Violation:  Failure to file the Report of Medical Evaluation in a timely manner (10 instances); failure to meet the compliance standard of 95 percent.

Texas Municipal League Intergovernmental Risk Pool of Austin
Order Number: DWC-09-0019
Date of Order:  3/19/2009
Order Final In:   March
Action Taken:  $5,000 Administrative Penalty
Violation:  Failure to pay the reasonable and necessary medical costs of treatments/services requiring preauthorization which were approved prior to providing the health care (four instances); inappropriate retrospective review of the medical necessity of preauthorized treatment or services (four instances).

Continental Casualty Company of Chicago, IL
Order Number: DWC-09-0015
Date of Order:  2/27/2009
Order Final In:   February
Action Taken:  $55,000 Administrative Penalty
Violation:  Inappropriate payment or denial of payment of 144 medical bills out of 517 bills reviewed; failure to meet compliance standard for data submission accuracy, timely reporting of medical bill data, or timely processing of medical bills.accuracy, timely reporting medical bill data, or timely processing medical bills.

Dr. Fortenberry, Dewitt C. of Texarkana
Order Number: DWC-09-0012
Date of Order:  2/25/2009
Order Final In:   February
Action Taken:  $1,500 Administrative Penalty
Violation:  Failure to file Report of Medical Evaluation in a timely manner.

National Fire Insurance Company of Chicago, IL
Order Number: DWC-09-0016
Date of Order:  2/27/2009
Order Final In:   February
Action Taken:  $12,000 Administrative Penalty
Violation:  Inappropriate payment or denial or payment of 41 medical bills out of 205 bills reviewed; failure to meet compliance standard for appropriate denial or reduction of a medical bill.

St. Luke's Episcopal Health System of Houston
Order Number: DWC-09-0011
Date of Order:  2/25/2009
Order Final In:   February
Action Taken:  $1,000 Administrative Penalty
Violation:  Improperly pursuing a private claim against a workers’ compensation claimant when the injury had not been finally adjudicated and the claimant had not been in violation of their selection of a doctor.

Transcontinental Insurance Company of Chicago, IL
Order Number: DWC-09-0014
Date of Order:  2/27/2009
Order Final In:   February
Action Taken:  $18,000 Administrative Penalty
Violation:  Inappropriate payment or denial of payment of 90 medical bills out of 318 medical bills reviewed; failure to meet the compliance standard for appropriate denial or reduction of a medical bill.

Transportation Insurance Company of Chicago, IL
Order Number: DWC-09-0013
Date of Order:  2/27/2009
Order Final In:   February
Action Taken:  $65,000 Administrative Penalty
Violation:  Inappropriate payment or denial of payment of 154 medical bills out of 422 medical bills reviewed; failure to meet the compliance standard for appropriate denial or reduction of a medical bill.

ACIG Insurance Company of Dallas
Order Number: DWC-09-0010
Date of Order:  1/30/2009
Order Final In:   January
Action Taken:  $2,000 Administrative Penalty
Violation:  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 Number: DWC-09-0001
Date of Order:  1/7/2009
Order Final In:   January
Action Taken:  $4,000 Administrative Penalty
Violation:  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 Number: DWC-09-0005
Date of Order:  1/8/2009
Order Final In:   January
Action Taken:  $22,500 Administrative Penalty
Violation:  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 Number: DWC-09-0007
Date of Order:  1/8/2009
Order Final In:   January
Action Taken:  $9,000 Administrative Penalty
Violation:  Late payment for preauthorized services (five instances); improper denial of partial payment for preauthorized services.

Murphy, Charles, M.D. of Plano, TX
Order Number: DWC-09-0003
Date of Order:  1/8/2009
Order Final In:   January
Action Taken:  $45,000 Administrative Penalty
Violation:   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.
view order

New Hampshire Insurance Company of Harrisburg, PA
Order Number: DWC-09-0006
Date of Order:  1/8/2009
Order Final In:   January
Action Taken:  $7,500 Administrative Penalty
Violation:  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).

Roberson, Eric, M.D. of Webster, TX
Order Number: DWC-09-0009
Date of Order:  1/30/2009
Order Final In:   January
Action Taken:  $12,300 Administrative Penalty
Violation:  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. view order

The Insurance Company of the State of Pennsylvania of Harrisburg, PA
Order Number: DWC-09-0004
Date of Order:  1/8/2009
Order Final In:   January
Action Taken:  $7,500 Administrative Penalty
Violation:  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).

Zurich American Insurance Company of Schaumburg, IL
Order Number: DWC-09-0002
Date of Order:  1/7/2009
Order Final In:   January
Action Taken:  $15,000 Administrative Penalty
Violation:  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).