454-16-1884-m4-np
DECISION AND ORDER Traveler’s Indemnity Company of Connecticut (Traveler’s) challenges a decision of the Texas Department of Insurance, Division of Worker’s Compensation (Division) that awarded American Specialty Pharmacy (American) reimbursement for a combination of several drugs compounded into a topical cream. Traveler’s appeared at the hearing and presented evidence in support of its position that, […]
454-16-1182-m4-np
DECISION AND ORDER The State Office of Risk Management (Carrier or SORM) sought a contested case hearing regarding a Medical Fee Dispute Decision (MFD Decision) issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division). The MFD Decision ordered Carrier to reimburse Monzer Yazji, M.D. (Provider) the additional sum of $600.00, plus interest, […]
454-16-0182-m4-np
DECISION AND ORDER ________ (Petitioner) seeks reimbursement from Transportation Insurance Co. (Carrier) for medical costs he allegedly incurred after being injured at work. Petitioner appeals the decision that Carrier is not required to reimburse him $18,838.17 because, among other things, the request for Medical Fee Dispute Resolution (MFDR) was untimely filed. The Administrative Law Judge […]
454-15-4237-m4-np
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) sought a contested case hearing regarding a Medical Fee Dispute Decision (MFD Decision) issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division). The MFD Decision ordered Carrier to reimburse Salman Khan, D.C. (Provider) the additional sum of $150.00 for an impairment rating (IR) evaluation […]
454-15-3669-m4-np
DECISION AND ORDER ___ (Carrier) sought a contested case hearing regarding a Medical Fee Dispute Decision (the MFD Decision) issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division). The MFD Decision ordered Carrier to reimburse Compliance Toxicology, LLC (Provider) $1,116.61 for services provided to an injured worker. The Administrative Law Judge (ALJ) […]
454-15-5218-m4-np
DECISION AND ORDER Affordable Hearing Care (AHC) seeks reimbursement of $12,533.60 from Petroleum Casualty Company (Petroleum) for services associated with dispensing hearing aids to a patient. Because AHC failed to timely submit its claim for payment to Petroleum in accordance with the Texas Labor Code and the rules of the Texas Department of Insurance, Division […]
454-10-0972-m4-etal
DECISION AND ORDER I. INTRODUCTION This docket was consolidated for hearing cases (hereinafter “Consolidated Docket,” listed on Attachment A) that involve the same legal issues and types of evidence. Each case purportedly[1] involves hospital outpatient services provided prior to March 1, 2008, by Vista Medical Center Hospital, Vista Hospital of Dallas, or Surgery Specialty Hospitals […]
454-15-3740-m4-np
DECISION AND ORDER This case involves services rendered by Physicians Center, PA (Physicians) 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 Indemnity Insurance Company of North America (Carrier) to reimburse Physicians in […]
454-15-0681-m4
DECISION AND ORDER This case involves challenges by numerous insurance companies (Carriers) to Medical Fee Dispute Resolution (MFDR) decisions by the Texas Department of Insurance, Division of Workers’ Compensation (DWC) ordering additional reimbursement for air ambulance services provided by PHI Air Medical (PHI). After considering the evidence and arguments presented, the Administrative Law Judge (ALJ) […]
454-13-2460-m4-etal
DECISION AND ORDER ON SUMMARY DISPOSITION This case involves a fee dispute for services rendered by Vista Medical Center Hospital (Provider) to an injured worker (Claimant). Provider seeks additional reimbursement from the Insurance Company of the State of Pennsylvania (Carrier) for services rendered to Claimant. Carrier filed a motion for summary disposition in this case, […]