453-04-8284-m4
DECISION AND ORDER American Mutual Casualty Company of Reading, Pa. (Carrier), requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[1] ordering additional reimbursement to Providence Memorial Hospital (Provider) for a hospital stay provided to Claimant, an injured worker. Provider argued that […]
453-05-6535-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)[1] regarding the reimbursement to Provider for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement for this admission should be […]
453-05-6808-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)[1] denying additional reimbursement to Provider for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement for this admission should be […]
453-05-7700-m4
DECISION AND ORDER Vista Hospital of Dallas (Provider) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[1] denying additional reimbursement to Provider for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement for this admission should be […]
453-05-9370-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)[1] denying additional reimbursement to Provider for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement for this admission should be […]
453-03-0571-m4
DECISION AND ORDER I. INTRODUCTION Vista Healthcare, Inc., (Vista) requested a hearing to contest decisions by the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission)[1] denying additional payment for ambulatory surgical center (ASC) services. Vista operated ASCs in the Houston area that provided outpatient surgical services to patients not requiring hospitalization. Vista […]
454-06-1284-c1
DECISION AND ORDER I. INTRODUCTION Staff of Texas Department of Insurance, Division of Workers’ Compensation (Staff/Division), Respondent, alleged that Justin C. Benedict, D.C., Petitioner, violated Tex. Labor Code Ann. § 415.003 and 28 Tex. Admin. Code (TAC) § 134.801 by submitting medical bills for aquatic therapy services that he did not provide. Dr. Benedict was […]
454-07-0892-p1
DECISION AND ORDER Continental Casualty Company (Carrier) challenges a Medical Interlocutory Order issued by the Texas Department of Insurance, Division of Workers’ Compensation (the Division), requiring Carrier to reimburse for medications provided by Co-Respondent Ronald Washington, M.D., to Claimant ____. This decision finds in favor of the Division and Dr. Washington. I. PROCEDURAL HISTORY, NOTICE, […]
453-05-7061-c1
DECISION AND ORDER I. INTRODUCTION On June 2, 2005, the staff of the Texas Department of Insurance, Division of Workers’ Compensation (Division) issued notices of violation to the _______ (the City), notifying it of various violations of Commission rules relating to the preauthorization for medical services provided to injured workers. On June 21, 2005, the […]
453-03-0505-m4
DECISION AND ORDER I. INTRODUCTION Vista Healthcare, Inc. (Vista) requested a hearing to contest a decision by the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission) denying additional payment for ambulatory surgical center services.[1] Vista operated ambulatory surgical centers (ASCs) in Houston, Texas, and provided surgical services to patients not requiring in-patient […]