DECISION AND ORDER

First Wellness Center appealed an independent review organization (IRO) determination denying its claim against the City of Houston (City) for care it provided to treat an injury suffered by a City employee.^[1] The City provided workers’ compensation coverage for its workers through a self-insurance program. First Wellness did not appear at the hearing and thus failed to carry its burden of proving it was entitled to payment. As a result, this decision concludes that its claim should be denied.

I. PROCEDURAL HISTORY

A hearing was held on February 2, 2004, before the undersigned Administrative Law Judge (ALJ) at the State Office of Administrative Hearings (SOAH), Austin, Texas. The City appeared and was represented by its attorney, William E. Weldon. The hearing closed on February 2, 2004.

II. DISCUSSION

Exhibits 1 and 2, received into evidence at the hearing, provided sufficient evidence to show that First Wellness received notice of the hearing. Exhibit 1 is a November 14, 2003, letter from Amara Tea, D.C., on First Wellness’s letterhead requesting a continuance of the case.^[2] The letter showed First Wellness’s Fax transmittal number as 713/974-6044. Exhibit 2 is the SOAH order setting the case to be heard at SOAH on February 2, 2004, at 11:00 a.m. FAX transmission pages attached to the order show that the order was faxed to and received at FAX number 713/974-6044.

As appellant, First Wellness had the burden of proving that the services it provided should

be paid.^[3] However, the only evidence presented at the hearing was Exhibits 1 and 2 to prove proper notice and the matters referred to in footnote 1. Because no evidence was presented to prove that First Wellness should be paid for its claim against the City, this decision concludes that its claim should be denied.

III. FINDINGS OF FACT

1. An injured worker for the City of Houston (City) received services from First Wellness Center performed from May 27, 2002, through June 7, 2002.
2. The City provided workers’ compensation coverage to its workers through a self-funded insurance program.
3. First Wellness Center submitted a claim to the City for the services it provided.
4. The City denied the claim.
5. First Wellness Center requested medical dispute resolution.
6. An independent review organization (IRO) concluded that the services should not be paid.
7. It is undisputed that First Wellness Center requested a hearing not later than the 20^th day after receiving notice of the IRO decision.
8. All parties received not less than 10 days’ notice of the time, place, and nature of the hearing; the legal authority and jurisdiction under which the hearing was to be held; the particular sections of the statutes and rules involved; and a short, plain statement of the matters asserted.
9. All parties had an opportunity to respond and present evidence and argument on each issue involved in the case.
10. There was no evidence presented to prove that First Wellness Center should be paid for its services.

V. CONCLUSIONS OF LAW

1. The State Office of Administrative Hearings has jurisdiction over this proceeding, including the authority to issue a decision and order. Tex. Lab. Code Ann. §413.031(k) and Tex. Gov’t Code Ann. ch. 2003.
2. All parties received adequate and timely notice of the hearing. Tex. Gov’t Code Ann. §§ 2001.051 and 2001.052.
3. First Wellness Center has the burden of proof. 1 Tex. Admin. Code (TAC) § 155.41(b); 28 Tex. Admin. Code §148.21(h).
4. First Wellness Center failed to carry its burden of proving the services should be paid. Tex. Lab. Code Ann. §§ 401.011 and 408.021.
5. First Wellness Center’s claim should be denied.

ORDER

IT IS THEREFORE ORDERED that First Wellness Center’s claim against the City of Houston for services provided to an injured City of Houston worker from May 27, 2002, through June 7, 2002, be, and the same is hereby, denied.

Signed February 6, 2004.

JAMES W. NORMAN
Administrative Law Judge
STATE OFFICE OF ADMINISTRATIVE HEARINGS

1. The Administrative Law Judge takes official notice of the IRO decision for the limited purpose of noticing the decision and that First Wellness performed the disputed services from May 27, 2002, through June 7, 2002.↑
2. The continuance was granted.↑
3. 1 Tex. Admin. Code (TAC) § 155.41(b); 28 TAC § 148.(h).↑