This appeal arises pursuant to the Texas Workers’ Compensation Act, TEX. LAB. CODE ANN. § 401.001 et seq. (1989 Act). A contested case hearing was held on September 4, 2001. The hearing officer resolved the disputed spinal surgery issue by deciding not to approve the appellant’s (claimant) request for spinal surgery. The claimant appealed and the respondent (carrier) responded.
DECISION
The hearing officer’s decision is affirmed.
The hearing officer did not err in denying the claimant’s request for spinal surgery. Section 408.026 and Tex. W.C. Comm’n, 28 TEX. ADMIN. CODE. § 133.206 (Rule 133.206) pertain to the spinal surgery second opinion process. Rule 133.206(a)(13) provides that a concurrence is a second opinion doctor’s agreement that the surgeon’s proposed type of spinal surgery is needed. Rule 133.206(a)(14) provides that a nonconcurrence is a second opinion doctor’s disagreement with the surgeon’s recommendation that a particular type of spinal surgery is needed. Rule 133.206(k)(4) provides that, of the three recommendations and opinions (the surgeon’s, and the two second opinion doctors’), presumptive weight will be given to the two which had the same result, and they will be upheld unless the great weight of the medical evidence is to the contrary; and that the only opinions admissible at the hearing are the recommendation of the surgeon and the opinions of the two second opinion doctors.
The claimant sustained a compensable injury on ______________. The claimant’s treating doctor referred the claimant to a surgeon and, in a Recommendation for Spinal Surgery (TWCC-63), the surgeon recommended that the claimant undergo a lumbar laminectomy at L5-S1. The carrier’s second opinion doctor examined the claimant and reported that she did not agree with the proposed surgery. The claimant’s second opinion doctor examined the claimant and reported that he agreed that surgery is indicated, but recommended a different procedure. The parties stipulated that the carrier’s second opinion doctor did not concur with the need for spinal surgery. The hearing officer found that the claimant’s second opinion doctor had not concurred with the recommended spinal surgery, and further found that the great weight of the other medical evidence is not contrary to the opinions of the two second opinion doctors. The hearing officer denied the claimant’s request for spinal surgery. The hearing officer’s decision is supported by sufficient evidence and is not so against the great weight and preponderance of the evidence as to be clearly wrong and unjust.
The hearing officer’s decision and order are affirmed.
The true corporate name of the insurance carrier is AMERICAN HOME ASSURANCE COMPANY and the name and address of its registered agent for service of process is
CORPORATION SERVICE COMPANY
800 BRAZOS, SUITE 750
COMMODORE 1
AUSTIN, TEXAS 78701.
Robert W. Potts – Appeals Judge
CONCUR:
Robert E. Lang
Appeals Panel
Manager/Judge
Michael B. McShane – Appeals Judge