454-24-08222.M4-NP
Decision and Order on Summary Disposition On or about January 2, 2024, the Texas Department of Insurance (TDI), Division of Workers’ Compensation (Division), referred this matter to the State Office of Administrative Hearings, wherein Mueller Surgery Center, LLC (Petitioner) seeks to appeal a Medical Fee Dispute Decision. On April 5, 2024, Respondent, Standard Fire Insurance […]
454-24-06559.M4-NP
DECISION AND ORDER This case involves physical therapy services rendered by Kamla Knight, DC (Provider) to an injured employee (Patient) covered by the workers’ compensation system. The Texas Department of Insurance, Division of Workers’ Compensation (Division) conducted a medical fee dispute resolution (MFDR) and declined to order Liberty Mutual Insurance Corporation (Carrier) to reimburse Provider […]
454-23-24074.M4-NP
DECISION AND ORDER Petitioner Crescent Regional Hospital (Provider) challenges the decision of the Texas Department of Insurance, Division of Workers’ Compensation (Division), which denied Provider’s claim for reimbursement from Hartford Casualty Insurance Company (Carrier) for services provided to an injured worker (Patient). The Administrative Law Judge (ALJ) finds that Provider demonstrated that the services provided […]
454-22-0705.M4-NP
DECISION AND ORDER Holmes Prosthetic Center, LLC (Holmes) sought additional reimbursement from Zurich American Insurance Company (Zurich) for services rendered to an injured worker (Claimant), who sustained a work-related compensable injury on _______. After reviewing the evidence presented and the applicable law, the Administrative Law Judge (ALJ) concludes that Zurich owes Holmes no additional reimbursement. […]
454-23-00628.M4-NP
Decision and Order Petitioner Executive Risk Indemnity (Carrier) challenges the decision of the Texas Department of Insurance, Division of Workers’ Compensation (Division), which ordered reimbursement of $39,111.59 to MHHS Hermann Hospital (Provider). The Administrative Law Judge (ALJ) finds that Provider did not provide the required documentation with its request for reimbursement and subsequent requests for […]
454-22-09437.M4-NP
DECISION AND ORDER An Administrative Law Judge (ALJ) with the Texas Department of Insurance, Division of Workers’ Compensation (Division) denied _______ reimbursement of about $39,000.00 in out-of-pocket medical expenses because his request for medical fee dispute resolution was too late—more than one year after his out-of-pocket medical expenses were incurred and more than 60 days […]
454-22-04410.M4-NP
Decision and Order Petitioner Travelers Indemnity Company of Connecticut (Carrier) challenges the decision of the Texas Department of Insurance, Division of Workers’ Compensation (Division) to order reimbursement of $16,750.00 to Respondent North Texas Pain Recovery Center (Provider). I. NOTICE, JURISDICTION, AND PROCEDURAL HISTORY Provider challenged the jurisdiction of the State Office of Administrative Hearings (SOAH) […]
454-21-3024.M4-NP, et al.
SOAH Docket Nos. 454-21-3024; 454-21-3104; 454-21-3139; 454-21-3164; 454-21-3168; 454-21-3169; 454-21-3253; 454-21-3254; 454-21-3255; 454-21-3103; 454-21-3105; 454-21-3167 Suffix: M4-NP MRD Nos. ____________ DECISION AND ORDER Zurich American Insurance Company, Baptist Hospitals of Southeast Texas, and Old Republic Insurance Company (collectively, Carriers) separately challenged twelve decisions of the Texas Department of Insurance, Division of Workers’ Compensation (the Division) […]
454-21-3304.M4-NP
DECISION AND ORDER North Texas Rehabilitation Center (Provider) challenges decisions of the Texas Department of Insurance, Division of Workers’ Compensation, Medical Review Division (MRD or Division) that denied Provider additional reimbursement from Great American Alliance Insurance Company (Carrier) for a program of interdisciplinary traumatic brain injury rehabilitation provided by Provider to (Claimant). In Docket No. […]
454-21-3451.M4-NP
DECISION AND ORDER North Texas Rehabilitation Center (Provider) challenges decisions of the Texas Department of Insurance, Division of Workers’ Compensation, Medical Review Division (MRD or Division) that denied Provider additional reimbursement from Great American Alliance Insurance Company (Carrier) for a program of interdisciplinary traumatic brain injury rehabilitation provided by Provider to (Claimant). In Docket No. […]