454-17-4926-m4-np
DECISION AND ORDER This case involves a claim for reimbursement of amounts billed for implantable surgical devices (implantables) used in a June 24, 2016 surgery on an injured worker. (Insurance Company) paid $31,589.53 of the amounts billed. In a medical fee dispute resolution (MFDR) before the Texas Department of Insurance Division of Workers Compensation (Division), […]
454-17-4371-m4-np
DECISION AND ORDER This case involves services rendered by WDS, M.D. to an injured employee covered by the workers’ compensation insurance system. The Texas Department of Insurance’s Division of Workers’ Compensation (Division) conducted medical fee dispute resolution (MFDR) and declined to order Carrier to reimburse Dr. S in the amount of $431.49. The Administrative Law […]
454-17-4188-m4-np
DECISION AND ORDER Injured worker R.G.W. challenges the Medical Fee Dispute Findings and Decision of the Texas Department of Insurance, Division of Worker’s Compensation (Division or DWC) that (Carrier) is not required to reimburse him $3,000 for the purchase of a full body massage chair that was not preauthorized by Carrier. The Administrative Law Judge […]
454-17-1460-m4-np
DECISION AND ORDER ______ (Millennium) challenges a decision of the Texas Department of Insurance, Division of Workers’ Compensation that denied its request for reimbursement for six functional capacity evaluations (FCEs) billed to Twin City Fire Insurance Co. (Twin City). On January 24, 2017, Twin City filed a Motion for Summary Disposition. On February 20, 2017, […]
454-17-0687-m4-np
DECISION AND ORDER Texas Mutual Insurance Company (TMIC) challenges a decision of the Texas Department of Insurance, Division of Workers’ Compensation (Division) holding that TMIC is liable for a medical bill from Medspring Urgent Care (Medspring) associated with the treatment of an injured worker. On November 16, 2016, TMIC filed a Motion for Summary Disposition […]
454-16-4910-m4-np
DECISION AND ORDER Old Republic Insurance Company (Old Republic) challenges a decision of the Texas Department of Insurance, Division of Workers’ Compensation (Division) that awarded Memorial Compounding Pharmacy (Memorial) reimbursement for a compound topical cream prepared by Memorial. Old Republic argued that, because the topical cream was not recognized by the Food and Drug Administration […]
454-16-5262-m4-np
DECISION AND ORDER The Insurance Company of the State of Pennsylvania (Carrier) challenges the Medical Fee Dispute Findings and Decision of the Texas Department of Insurance, Division of Worker’s Compensation (Division or DWC), that ordered Carrier to pay an additional $1,572.45 to Physicians Surgical Center (Provider) for implantables used by Provider during surgery performed on […]
454-16-3686-m4-np
DECISION AND ORDER Hanger Prosthetics and Orthotics (Hanger) challenges a decision of the Texas Department of Insurance, Division of Worker’s Compensation (Division) that denied Hanger’s claim for reimbursement for prostheses and prosthetic services. Old Republic Insurance Company (Old Republic) argues that Hanger failed to timely file its request for Medical Fee Dispute Resolution and failed […]
454-15-3738-m4-np
DECISION AND ORDER Texas Mutual Insurance Company (TMIC) challenges a decision of the Texas Department of Insurance, Division of Workers’ Compensation (Division) holding that TMIC is liable for a medical bill from J. Thomas Dilger, Jr., M.D., associated with the treatment of an injured worker. On April 22, 2016, TMIC filed a Motion for Summary […]
454-16-2156-m4-np
DECISION AND ORDER ______ (Carrier) challenges a decision of the Texas Department of Insurance, Division of Worker’s Compensation that awarded Healthtrust full reimbursement for a chronic pain management program. In support of its assertion that Healthtrust is not entitled to $2,012.50 of the amount billed, ___ (carrier) argues that the program’s afternoon sessions were not […]