454-10-3201-m5
DECISION AND ORDER Petitioner Injury 1 Treatment Center (ITC) seeks reimbursement of $12,352.00 for work hardening services it provided the Claimant, ____. The Administrative Law Judge (ALJ) finds the Carrier, ____, Self Insurance Fund (___SIF), should reimburse ITC the full amount, and so orders. I. HISTORY, NOTICE, AND JURISDICTION The Claimant sustained a compensable work-related […]
454-09-3006-m5
DECISION AND ORDER __(__) seeks relief from an order of the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC), requiring it to reimburse Horizon Health (Horizon) $14,398.29 for treatment provided to an injured city employee (Claimant) during 2004. The Administrative Law Judge (ALJ) concludes __ proved the treatment […]
454-10-3238-m4
DECISION AND ORDER Integra Specialty Group, P.A. (Provider) requested a hearing to contest a medical fee dispute resolution order issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division) regarding medical services provided to __. (Claimant). In its order, the Division found that Provider was entitled to reimbursement only in the amount of […]
454-10-1574-m4
DECISION AND ORDER I. INTRODUCTION Petitioner ___ requested a hearing to contest the decision by Medical Fee Dispute Resolution of the Texas Department of Insurance, Division of Workers’ Compensation denying payment for chiropractic treatment. The hearing convened on April 19, 2010, and the record closed on April 23, 2010, to allow the parties to provide […]
454-09-5024-m4
DECISION AND ORDER Killeen Injury Clinic (Provider) requested a hearing to contest a medical fee dispute resolution order issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division) regarding $5,265.80 in medical services provided to ___ (Claimant). In its order, the Division found that Petitioner was not entitled to reimbursement from Union Standard […]
454-09-5469-m4
DECISION AND ORDER Petitioner, Injury One Treatment Center (Injury One) seeks reimbursement for health care services it provided the Claimant, ____. The Administrative Law Judge (ALJ) finds the Respondent, Fidelity & Guaranty Insurance (Fidelity) should be required to reimburse Injury One an additional $2,216.17, for the reasons described below. I. HISTORY, JURISDICTION, AND NOTICE The […]
454-09-5290-m4
DECISION AND ORDER Injury 1 Treatment Center (Provider) requested a hearing to contest a medical fee dispute resolution order issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division) regarding $8,500 in medical services provided to __. (Claimant). In its order, the Division found that Provider was entitled to no reimbursement from Texas […]
454-09-4737-m4
DECISION AND ORDER Patrick Cindrich, M.D. (Provider) requested a hearing to contest a medical fee dispute resolution order issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division) regarding medical services provided to ___ (Claimant). In its order, the Division found that Provider was not entitled to reimbursement in the amount of $16,508.00 […]
454-08-2766-m5
DECISION AND ORDER Petitioner Ark-La-Tex Health Center, Inc. (ALTHC) seeks reimbursement of $6,626.00 for spinal manipulation therapy and electrical stimulation it provided the Claimant, ___, during 2006. The Administrative Law Judge concludes ALTHC proved the medical necessity of the spinal manipulation therapy, but not that of the electrical stimulation. He orders reimbursement of $4,806.00, which […]
454-09-3458-m4
DECISION AND ORDER Charles Osborn, M.D., Petitioner, seeks reimbursement of $12,000 in unreimbursed expenses for a chronic pain management program provided the Claimant, ___. The Administrative Law Judge (ALJ) concludes Dr. Osborn should be reimbursed an additional $8,000. This decision so orders. I. HISTORY, JURISDICTION, AND NOTICE The Claimant sustained a compensable injury on_____. Respondent, […]