Penalty of the month
The largest fine levied against an insurance carrier in May was for $9,000.00 in
Consent Order 2024-8648 dated May 7, 2024. Violations included failure to timely pay TIBs, failure to timely act on a medical bill, failure to timely pay a designated doctor, and failure to respond to an injured employee’s request for reimbursement.
The facts that caught our attention were for failing to respond to an injured employee’s request for reimbursement. The order states that the injured employee obtained a travel reimbursement form from the carrier’s third-party administrator (TPA) website. However, this form did not contain any language explaining the proper method for submitting travel reimbursement requests under DWC rules.
When the employee submitted the request on this form, the carrier failed to respond and failed to direct the employee to use form DWC048, Request to Get Reimbursed for Travel Expenses. In its defense, the carrier “cited the injured employee’s use of its own form as justification for the late payment.” In other words, the carrier argued that it did not timely respond because the employee used the wrong form (which they gave the employee).
This argument clearly did not go over well with DWC given that DWC chose to include it as a finding of fact in the consent order. This order serves as a good reminder that carriers are responsible for the acts of their agents and need to keep a close eye on them.
