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At a Glance:
Title:
08045
Date:
April 9, 2008
Status:
Concurrent Medical Necessity

08045

April 9, 2008

DECISION AND ORDER

This case is decided pursuant to Chapter 410 of the Texas Workers’ Compensation Act and Rules of the Division of Workers’ Compensation adopted thereunder.

ISSUE

A benefit contested case hearing was held on April 9, 2008, to decide the following disputed issue:

Whether the preponderance of the evidence is contrary to the decision of the Independent Review Organization (IR0) that a right psoas compartment plexus block with Botox chemodenervation with fluoroscopic guidance is a reasonable and necessary health care service for the compensable injury of __?

PARTIES PRESENT

Claimant appeared by phoned and was assisted by an (Ombudsman). Carrier appeared by phone and was represented by an (Attorney).

AGREEMENT

The parties reached an agreement. The agreement only resolves the issues to be decided at this hearing. The agreement does not resolve all issues regarding the claim and is not a settlement.

In this decision, this Agreement section includes findings of fact and the Decision Section constitutes the conclusions of law.

Hearing Officer Findings:

  • Venue is proper in the (City) Field Office of the Texas Department of Insurance, Division of Workers’ Compensation.
  • On __, Claimant was the employee of (Employer) when she sustained a compensable injury.
  • Carrier delivered to Claimant a single document stating the true corporate name of Carrier, and name and street address of Carrier's registered agent.

The parties agreed to the following:

The preponderance of the evidence is not contrary to the decision of the Independent Review Organization (IR0) that a right psoas compartment plexus block with Botox chemodenervation with fluoroscopic guidance is a reasonable and necessary health care service for the compensable injury of __.

CONCLUSIONS OF LAW

  1. The Texas Department of Insurance, Division of Workers’ Compensation, 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 decision of the IR0 that a right psoas compartment plexus block with Botox chemodenervation with fluoroscopic guidance is a reasonable and necessary health care service for the compensable injury of __.

DECISION

The preponderance of the evidence is not contrary to the decision of the IR0 that a right psoas compartment plexus block with Botox chemodenervation with fluoroscopic guidance is a reasonable and necessary health care service for the compensable injury of __.

ORDER

Carrier is ordered to pay benefits in accordance with this decision, the Texas Workers’ Compensation Act, and the Commissioner’s Rules. Accrued but unpaid income benefits, if any, shall be paid in a lump sum together with interest as provided by law.

The true corporate name of the insurance carrier is CONTINENTAL CASUALTY COMPANY and the name and address of its registered agent for service of process is:

CT CORPORATION SYSTEM

350 NORTH ST. PAUL STREET

DALLAS, TX 75201

Signed this 9th day of April, 2008.

Carol A. Fougerat
Hearing Officer

End of Document
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