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Division of WC Announces Enforcement Actions for Dec. 2008 and Jan.
2009
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TEXAS DEPARTMENT OF INSURANCE
DIVISION OF WORKERS' COMPENSATION
FOR IMMEDIATE RELEASE: March 4, 2009
FOR MORE INFORMATION
John Greeley or Ben Gonzales @ (512) 463-6425 |
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AUSTIN, TX — 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 December 2008 and January 2009. The final
actions include orders assessing administrative penalties totaling
$169,800 for violations of the Texas Labor Code and rules promulgated by
the Commissioner of Workers' Compensation. 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 DECEMBER
2008 THROUGH JANUARY 2009 (alphabetical order)
Ace American Insurance Company of Philadelphia, PA
Order No.: DWC-08-0094
Date of Order: December 19, 2008
Action Taken: Fined $37,500
Violation(s): 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 (10 instances).
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ACIG Insurance Company of Dallas
Order No.: DWC-09-0010
Date of Order: January 30, 2009
Action Taken: Fined $2,000
Violation(s): Failure to take final action on a medical bill no
later than the 45th day following receipt.
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American Casualty Company of Reading Pennsylvania of Chicago, IL
Order No.: DWC-09-0001
Date of Order: January 7, 2009
Action Taken: Fined $4,000
Violation(s): 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.
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American Home Assurance Company of New York City, NY
Order No.: DWC-09-0005
Date of Order: January 8, 2009
Action Taken: Fined $22,500
Violation(s): 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).
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Fidelity and Guaranty Insurance Company of Saint Paul, MN
Order No.: DWC-09-0007
Date of Order: January 8, 2009
Action Taken: Fined $9,000
Violation(s): Late payment for preauthorized services (five
instances); improper denial of partial payment for preauthorized
services.
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Indemnity Insurance Company of North America of Philadelphia, PA
Order No.: DWC-08-0095
Date of Order: December 19, 2008
Action Taken: Fined $7,500
Violation(s): 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).
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The Insurance Company of the State of Pennsylvania of Harrisburg,
PA
Order No.: DWC-09-0004
Date of Order: January 8, 2009
Action Taken: Fined $7,500
Violation(s): 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).
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Physician Fined
in Plano
Order No.: DWC-09-0003
Date of Order: January 8, 2009
Action Taken: Fined $45,000
Violation(s): 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.
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New Hampshire Insurance Company of Harrisburg, PA
Order No.: DWC-09-0006
Date of Order: January 8, 2009
Action Taken: Fined $7,500
Violation(s): 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).
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Physician Fined
in Webster
Order No.: DWC-09-0009
Date of Order: January 30, 2009
Action Taken: Fined $12,300
Violation(s): 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.
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Zurich American Insurance Company of Schaumburg, IL
Order No.: DWC-09-0002
Date of Order: January 7, 2009
Action Taken: Fined $15,000
Violation(s): 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).
# # #
T E X A S D E P A R T M E N T O F I N S U R A N C E
Public Information Office – 333 Guadalupe St., Austin, TX 78701 - ph.
(512) 463-6425 - fax (512) 463-6141 /
website
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Another Bill To Change Requirements For WC Reviewers
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Legislation
introduced by Rep. David Leibowitz, D-San Antonio, would change
the requirements again for doctors providing review services under
the Texas workers' compensation system.As you may recall, last
Legislative session there was similar legislation.
House Bill 1166 would amend Section 408.0043 of the Texas Labor
Code, as it pertains to professional specialty certification
required for certain
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reviews, to provide that the reviewing
practitioner hold the same professional certification as the
employee's treating doctor, be licensed in the State of Texas,
maintain his or her primary practice location in Texas, and be
actively engaged in the treatment of patients in Texas.
The bill also provides that independent review organizations that
employ doctors to perform reviews of health care services may only use
doctors who are licensed to practice in Texas, who are actively
engaged in the treatment of patients in Texas and whose primary
practice location is in the state.
The requirement that review doctors must be actively engaged in the
treatment of patients would prevent retired doctors and doctors whose
practice is inactive from reviewing workers' compensation health care.
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This Week In Texas: Mignon
McGarry Memos
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By Mignon McGarry
TOA Legislative Advocate
TOA Online Version: All Memos
March 11, 2009, Wednesday
As I write this,
roughly 5147 bills and joint resolutions have been filed by
members of the Texas House and Senate. That number is over
950
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more than filed during the last
legislative session in 2007. By Friday evening's deadline, we
should be well over 6000 pieces of legislation filed. That's
a lot of legislation to consider in 82 days, the amount of
time left in the 81st legislative session.
Other than the filing of hundreds of pieces of legislation, the main
action at the Capitol this week was the debate in the Texas Senate of
Senate Bill 362 relating to requiring a voter to present proof of
identification. In a rare move, the Senate met as a Committee of the
Whole to debate and take testimony on the bill. After an all night
session that began on Tuesday morning, the Senate finally wound up
their hearing around 9:30am today and passed the bill out of the
Committee of the Whole on a party line vote of 20 ayes and 12 nays.
The Lt. Governor, in his role as President of the Senate, is allowed
to cast a vote in the Committee of the Whole. Senate Bill 392 now
moves to a floor vote on Monday.
Are
you curious about how the state of Texas will be dealing with stimulus
funds headed this way from the federal government? Then click
here to
take a look at the Texas House's website to track the money that comes
through the state government. Comptroller
Susan Combs also has a
link on her website which can be found by clicking
here to make the stimulus spending transparent.
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Bill Would Effect Return-to-Work Practices in Comp
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Rep. Helen
Giddings, D-Dallas, has introduced legislation dealing with
descriptions of employment for use in determining when it is
safe and appropriate for an injured employee to return to
work.
HB 2547 would add Sec. 408.0221 to the Labor Code to require
that "to facilitate an injured employee's return to employment
as soon as it is considered safe and appropriate by the
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doctor, the injured employee's
employer shall provide the treating doctor, on request," a
specific description of:
The bill provides that a
description provided to a treating doctor does not constitute:
The legislation would apply only
to employers with 75 or more employees.
The change in the law would apply only to a claim for workers'
compensation benefits based on a compensable injury that
occurs on or after the effective date of the act, which is
Sept. 1.
For HB 2547 please click
here.
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Red Alert: SB 152
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This is no
fire drill – this is a RED ALERT on Senate Bill 152 Relating
to the standard of proof in health care liability claims
involving emergency care – any physician providing emergency
care. Take action NOW!
We expect Senate Bill 152 to be scheduled for a committee
hearing in the Senate State Affairs Committee next Thursday,
March 19th. It is critical for TOA members to let the Senators
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Affairs know how we feel about this
bill. Please send each of these Senators an email or letter ASAP. A list
of Senate State Affairs Committee members and their contact information
is included below. A draft letter follows. Please pass this email on to
your colleagues and urge them to do the same.
Dear SENATOR ________,
Re: Please Oppose Senate Bill 152
As a physician practicing in Texas, I'm writing in support of the 2003
medical liability reforms and for safeguarding these reforms.
Thanks to the Texas Legislature's passage of medical liability reforms
in 2003, patients across the state now have significantly improved
access to critical health care. The reforms' success is indisputable:
Texas licensed 10,878 new physicians in the four years after reform; a
30 percent increase from the previous four years.
These reforms are working and need to be protected. Please oppose any
efforts to alter or amend this reform legislation, such as Senate Bill
152 relating to the standard of proof in health care liability claims
involving emergency care which is likely to come before the Senate State
Affairs Committee next week.
Medical liability reforms are about saving lives, and we are where we
should be in Texas. Please help us protect the gains we've made and
continue our momentum in expanding access to quality medical care in all
parts of Texas.
Thank you in advance for your support of these crucial medical liability
reforms.
Sincerely,
SENATE STATE AFFAIRS COMMITTEE
All letters should be addressed as follows:
The Honorable (Full Name)
Texas Senate
P.O. Box 12068 – Capitol Station
Austin, Texas 78711
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