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At a Glance:
Title:
08009
Date:
December 12, 2007
Status:
Concurrent Medical Necessity

08009

December 12, 2007

DECISION AND ORDER

This case is decided under the Texas Workers' Compensation Act (the Act), Tex. Labor Code Ann. §410.151 - 410.169 (Vernon 2006) and Tex. Workers' Comp. Comm'n, 28 Tex. Admin. Code §142.1 - 142.20 (West).

ISSUES

A Benefit Contested Case Hearing (BCCH) was held on November 16, 2007, to decide the following disputed issue:

Is the preponderance of the evidence contrary to the Independent Review Organization (IRO) report that an amputation of the right thumb at the distal 3rd with full thickness skin graft is not reasonable and necessary medical treatment for the compensable injury of ____?

PERSONS PRESENT

Claimant did not appear at the hearing and also did not respond to a 10-day letter. Carrier appeared and was represented by attorney.

BACKGROUND INFORMATION

The Claimant did not appear for the Contested Case Hearing scheduled for November 16, 2007, at 2:00 p.m. A letter was sent to the Claimant on November 19, 2007, offering him an opportunity to request that the hearing be reset to permit him to present evidence on the disputed issue. No response to that letter was received. Since the Claimant failed to appear and present evidence in support of the disputed issues, the Claimant has not met his burden of proof on those issues.

Even though all the evidence presented was not discussed, it was considered. The Findings of Fact and Conclusions of Law are based on all of the evidence presented.

FINDINGS OF FACT

  1. The true corporate name of the insurance carrier is American Casualty Company of Reading, PA., and the name and address of its registered agent for service of process is CT Corporation System, 350 N. St. Paul Street, Dallas, TX 75201.

2.The Division sent a single document stating the true corporate name of the Carrier and name and street address of Carrier’s registered agent with the 10-day letter to the Claimant at his address of record. That document was admitted into evidence as Hearing Officer Exhibit No. 2.

  • On ____, the Claimant lived within 75 miles of the (City) Field Office.
  • On ____, the Claimant was an employee of Employer.
  • On ____, the Employer was a subscriber to a policy of workers’ compensation insurance issued by the Carrier.
  • The Claimant failed to appear for the November 16, 2007, Contested Case Hearing and did not respond to the Division’s letter offering him an opportunity to have the hearing rescheduled.
  • The IRO upheld the Carrier's denial of an amputation of the right thumb at the distal 3rd with full thickness skin graft as not being reasonable and necessary treatment for the compensable injury of ____.
  • No evidence was received that showed that the preponderance of the evidence is contrary to the IRO report.
  • No evidence was received that showed that the Claimant had good cause for his failure to appear for the Contested Case Hearing.
  • CONCLUSIONS OF LAW

    1. The Texas Workers' Compensation Division has jurisdiction to hear this case.
    2. Venue was proper in the (City) Field Office.
    3. The preponderance of the evidence is not contrary to the IRO report that an amputation of the right thumb at the distal 3rd with full thickness skin graft is not reasonable and necessary medical treatment for the compensable injury of ____.

    DECISION

    The preponderance of the evidence is not contrary to the IRO report that an amputation of the right thumb at the distal 3rd with full thickness skin graft is not reasonable and necessary medical treatment for the compensable injury of ____.

    ORDER

    Carrier is not liable for benefits at issue in this hearing. The Claimant remains entitled to medical benefits for the compensable injury in accordance with Texas Labor Code Section 408.021.

    Signed this 12th day of December 2007

    DONALD E. WOODS
    Hearing Officer

    End of Document
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