Division of Workers’ Compensation Announces 2014 Enforcement Actions
Thursday, February 12, 2015 03:44 PM

Commissioner of Workers’ Compensation Ryan Brannan recently announced final disciplinary actions taken by the Division of Workers’ Compensation (DWC) in 2014.  The final actions include administrative penalties ordered against insurance carriers, health care providers and employers in the workers’ compensation system.

Since January 1, 2014, the Commissioner of Workers’ Compensation has ordered administrative penalties totaling $2,238,845 against system participants. The penalties include $2,086,395 in fines ordered against insurance carriers, $106,450 in fines ordered against health care providers, $45,000 in fines ordered against other entities and $1,000 in fines ordered against employers.

Violations of the Texas Labor Code and related rules by insurance carriers cited in recent orders include failing to timely pay income benefits to an injured employee, failing to timely pay a medical bill, and retrospectively reviewing the medical necessity of a preauthorized medical service or treatment. Violations cited in orders naming health care providers include administering unreasonable or medically unnecessary treatment or services and failing to adequately assess and monitor injured employees when prescribing opioids. Violations cited in orders naming other entities include adjusters performing utilization reviews and issuing medical necessity denials without allowing the health care provider a reasonable opportunity to discuss the clinical basis for a denial of preauthorization with the appropriate doctor or health care provider performing the review prior to the issuance of a preauthorization or concurrent review denial.

Summaries of disciplinary actions are available on the TDI website at: https://wwwapps.tdi.state.tx.us/inter/asproot/commish/da/dwcclips2014.asp.

Specific order summaries also can be viewed by searching by the subject of the order here:
http://www.tdi.texas.gov/commish/actions.html.

Copies of Commissioner of Workers' Compensation orders also may be obtained by calling Maria Jimenez, TDI-DWC Enforcement, at 512-804-4703 or via e-mail to Maria.Jimenez@tdi.texas.gov.