454-22-0004.M4-NP
DECISION AND ORDER Columbia Mutual Insurance Co. (Columbia) challenges the Medical Fee Dispute Findings and Decision (MFD Decision) issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division). The MFD Decision ordered Columbia to reimburse the Texas Institute for Surgery (Provider) the additional sum of $1,804.48 for implantables used during outpatient surgery provided […]
454-21-3314.M4-NP
DECISION AND ORDER Texas Public School Workers’ Compensation Project (Carrier) challenges the Texas Department of Insurance, Division of Workers’ Compensation (the Division or DWC) Medical Fee Dispute Resolution (MFDR) Findings and Decision of July 3, 2020 (Decision) granting reimbursement to Baylor Scott & White Marble Falls (Hospital). The Administrative Law Judge (ALJ) finds that Hospital […]
454-21-3287.M4-NP
DECISION AND ORDER This case involves ambulatory surgical services rendered by Laser Surgery Holding Company, Ltd. (Provider) to an injured employee covered by the workers’ compensation insurance system. The Texas Department of Insurance, Division of Workers’ Compensation (Division) conducted medical fee dispute resolution (MFDR) and declined to order Texas Mutual Insurance (Carrier) to reimburse Provider […]
454-22-0040.M4-NP
DECISION AND ORDER The State Office of Risk Management (SORM) challenges the decisions of the Texas Department of Insurance, Division of Workers’ Compensation (Division) to award additional reimbursement to Angleton Rehabilitation and Wellness (Angleton) for physical therapy services provided for an injured worker in April-July 2020. SORM preauthorized the physical therapy sessions, but denied payment […]
454-22-0043.M4-NP
DECISION AND ORDER The State Office of Risk Management (SORM) challenges the decisions of the Texas Department of Insurance, Division of Workers’ Compensation (Division) to award additional reimbursement to Angleton Rehabilitation and Wellness (Angleton) for physical therapy services provided for an injured worker in April-July 2020. SORM preauthorized the physical therapy sessions, but denied payment […]
454-22-0044.M4-NP
DECISION AND ORDER The State Office of Risk Management (SORM) challenges the decisions of the Texas Department of Insurance, Division of Workers’ Compensation (Division) to award additional reimbursement to Angleton Rehabilitation and Wellness (Angleton) for physical therapy services provided for an injured worker in April-July 2020. SORM preauthorized the physical therapy sessions, but denied payment […]
454-22-0045.M4-NP
DECISION AND ORDER The State Office of Risk Management (SORM) challenges the decisions of the Texas Department of Insurance, Division of Workers’ Compensation (Division) to award additional reimbursement to Angleton Rehabilitation and Wellness (Angleton) for physical therapy services provided for an injured worker in April-July 2020. SORM preauthorized the physical therapy sessions, but denied payment […]
454-22-0039.M4-NP
DECISION AND ORDER The State Office of Risk Management (SORM) challenges the decisions of the Texas Department of Insurance, Division of Workers’ Compensation (Division) to award additional reimbursement to Angleton Rehabilitation and Wellness (Angleton) for physical therapy services provided for an injured worker in April-July 2020. SORM preauthorized the physical therapy sessions, but denied payment […]
454-19-0171.m4-np-etal
DECISION AND ORDER ON MOTIONS FOR SUMMARY DISPOSITION Petitioner, the State Office of Risk Management (SORM), and Respondent, Memorial Compounding Pharmacy (Memorial) both filed Motions for Summary Disposition in these cases. SORM’s Motion is GRANTED; Memorial’s is DENIED. The Administrative Law Judge (ALJ) determines that Memorial should not be reimbursed for the amounts at issue. […]
453-99-1809-m4
ORDER GRANTING PLEA IN JURISDICTION The Texas Workers’ Compensation Commission filed a Plea in Jurisdiction seeking Summary Dispositions in the above cases. The cases were consolidated into one hearing with five other cases involving the same parties and similar facts, but the Plea in Jurisdiction involves only the two cases numbered above. The entire group […]