454-08-4148-m4
DECISION AND ORDER John C. Milani, M.D., requested a hearing to contest a decision by the Texas Department of Insurance, Workers Compensation Division (Division) Medical Review Division (MRD), which determined that the Division had no jurisdiction over his medical fee dispute (dispute) with ACE USA/ESIS (Carrier). MRD based its decision on its finding that Dr. […]
454-08-1436-m5
DECISION AND ORDER On April 11, 2008, before the scheduled hearing in this case, Respondent Liberty Mutual Insurance Company (LMIC) filed its Motion to Dismiss for Lack of Jurisdiction. The Administrative Law Judge (ALJ) concludes that motion should be granted, this case should be dismissed with prejudice from the docket of the State Office of […]
454-08-3755-m4
DECISION AND ORDER Petitioner, Harris County Hospital District (HCHD) seeks reversal of an order requiring payment of $20,000 for a chronic pain management program conducted by Respondent, Dr. Glenn J. Bricken, Psy. D., for Claimant ___. The Administrative Law Judge (ALJ) finds HCHD did not prove that the program was not medically necessary to treat […]
454-08-2769-m4
DECISION AND ORDER ON MOTIONS FOR SUMMARY DISPOSITION I. INTRODUCTION Texas Mutual Insurance Company (Carrier) filed a Motion for Summary Disposition (Carrier’s Motion), contending that the claim for payment submitted by Texas Health LLC (Provider) in this case should be denied because Provider was required to obtain preauthorization for the services rendered, but failed to […]
454-08-2330-m4
DECISION AND ORDER Integra Specialty Group, P.A., (Provider) contested a medical fee dispute resolution decision issued by the Texas Department of Insurance-Division of Workers’ Compensation (Division)[1] denying compensation to Provider for work hardening services on the basis that Provider failed to document that it had provided all of the interdisciplinary services comprising work hardening. At […]
454-08-0835-m4
DECISION AND ORDER Jeffrey Buncher, M.D. (Provider) appeals a decision of the Texas Department of Insurance, Division of Workers Compensation (the Division) denying reimbursement of $3,600[1] from Travelers Indemnity Company (Carrier) for an Independent Medical Evaluation (IME) of Claimant. The Division found Provider did not submit his bill for payment (the claim) to Carrier within […]
453-05-5453-m4
DECISION AND ORDER Vista Medical Center Hospital (Provider) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[2] denying additional reimbursement for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement for this admission should be based on […]
453-05-5843-m4
DECISION AND ORDER Vista Medical Center Hospital (Provider) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[2] denying additional reimbursement for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement for this admission should be based on […]
453-05-7164-m4
DECISION AND ORDER Vista Medical Center Hospital (Provider) and Twin City Fire Insurance Company (Carrier) both requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[2] ordering additional reimbursement for a hospital stay provided to Claimant, an injured worker. Provider argued that […]
453-05-7157-m4
DECISION AND ORDER Vista Medical Center Hospital (Provider) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[2] denying additional reimbursement for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement for this admission should be based on […]