Title: 

APD 042553

Significant Decision

Date: 

November 19, 2004

Issues: 

Spinal Surgery Issue Code

Table of Contents

APD 042553

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 8, 2004. The hearing officer determined that the decision of the Independent Review Organization (IRO), finding that surgery for appellant (claimant) is medically necessary, is not supported by a preponderance of the evidence. Claimant appealed this determination, contending that the evidence shows the surgery is reasonable and necessary. Respondent (carrier) responded that the hearing officer did not err in making his determination.

DECISION

We affirm.

The applicable law and our appellate standard of review are discussed in Texas Workers’ Compensation Commission Appeal No. 021958-s, decided September 16, 2002. The hearing officer concluded that the decision of the IRO was not supported by a preponderance of the evidence. We have reviewed the complained-of determination and conclude that the issue involved a fact question for the hearing officer. The hearing officer reviewed the record and decided what facts were established. We conclude that the hearing officer’s determination is supported by the record and is not so against the great weight and preponderance of the evidence as to be clearly wrong or manifestly unjust. Cain v. Bain, 709 S.W.2d 175, 176 (Tex. 1986).

We affirm the hearing officer’s decision and order.

According to information provided by carrier, 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.

Judy L. S. Barnes – Appeals Judge

CONCUR:

Gary L. Kilgore – Appeals Judge

Veronica L. Ruberto – Appeals Judge