454-12-6138-m4
DECISION AND ORDER XL Specialty Insurance Co. (Carrier) challenges the Medical Fee Dispute Findings and Decision of the Texas Department of Insurance, Division of Worker’s Compensation (DWC), Medical Review Division (MRD), that ordered reimbursement of an additional $21,895.07 to PRIDE (Provider) for medical services provided to an injured worker (Claimant). The Administrative Law Judge (ALJ) […]
454-14-0405-m4
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) challenges the order granting additional reimbursement to Doctors Hospital at Renaissance (Provider) for services provided to an injured worker. The issue in this case is whether Provider is entitled to reimbursement for services billed under Current Procedural Terminology code (CPT) 29879. Carrier contends, based on applicable fee […]
454-13-0142-m4
DECISION AND ORDER BASED UPON STIPULATIONS Texas Mutual Insurance Company (TMIC) challenges the award of additional reimbursement to Doctors Hospital at Renaissance (DHR) for hospital outpatient services performed at DHR for an injured worker in ____ 2010. The parties have stipulated that TMIC paid the amount due DHR under the applicable fee guideline. The Administrative […]
454-13-2593-m4
DECISION AND ORDER TPCIGA for Reliance National Indemnity Company, an Impaired Carrier (Carrier), challenges the Texas Department of Insurance, Division of Workers’ Compensation (DWC) Medical Fee Dispute Resolution Findings and Decision of December 28, 2012 (Decision) requiring additional reimbursement of $6,125.75 to Garland Community Hospital (Provider). The Administrative Law Judge (ALJ) finds that Carrier has […]
454-13-3772-m4
DECISION AND ORDER Castlepoint National Insurance (Castlepoint) requested a hearing before the State Office of Administrative Hearings (SOAH) to challenge a Medical Fee Dispute Resolution Findings and Decision ordering it to reimburse Discovery Health Services (Discovery) $15,852.97 for chronic pain management (CPM) services provided to an injured worker (Claimant). Administrative Law Judge (ALJ) Gary Elkins […]
454-13-3807-m4
DECISION AND ORDER Travelers Indemnity Company (Carrier) challenges the Medical Fee Dispute Findings and Decision of the Texas Department of Insurance, Division of Worker’s Compensation (Division), that ordered reimbursement of an additional $3,345.04 to Harlingen Medical Center (Provider) for medical services provided to an injured worker (Claimant). The Administrative Law Judge (ALJ) concludes that Carrier […]
454-13-0601-m4
DECISION AND ORDER Facility Insurance Corporation (Carrier) challenges the October 1, 2012 Medical Fee Dispute Resolution Findings and Decision (MFDR Decision) of the Texas Department of Insurance, Division of Workers’ Compensation (Division). The MFDR Decision ordered Carrier to pay $14,309.72 in reimbursement to Methodist Hospital (Provider). The Administrative Law Judge (ALJ) finds that Provider did […]
454-13-3947-m4
DECISION AND ORDER Facility Insurance Corporation (Carrier) challenges the order granting additional reimbursement to Patients Medical Center (Provider) for services provided to an injured worker. The Administrative Law Judge (ALJ) concludes that Provider is entitled to additional reimbursement from Carrier for the services provided. I.JURISDICTION, NOTICE, AND PROCEDURAL HISTORY There are no issues of notice […]
454-13-0111-m4
DECISION AND ORDER BASED UPON STIPULATIONS Pacific Employers Insurance Company (PEIC) challenges the award of additional reimbursement to Texas Orthopedic Hospital (TOH) for hospital outpatient services performed at TOH for an injured worker on August 8-9, 2008. The parties have stipulated the PEIC paid the amount due TOH under the applicable fee guideline. The Administrative […]
454-13-4648-m4
DECISION AND ORDER Texas Mutual Insurance Company (TMIC) challenges the Texas Department of Insurance, Division of Workers’ Compensation (DWC) Medical Fee Dispute Resolution Findings and Decision of April 26, 2013 (Decision) ordering TMIC to pay Metropolitan Methodist Hospital (MMH) $9,011.34 for inpatient hospital surgical services provided to an injured worker during the period January 3, […]