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.
A benefit contested case hearing was held on March 24, 2008, to decide the following disputed issue:
- Whether the preponderance of the evidence is contrary to the decision of Medical Review that (Dr. SL), is entitled to $863.03 plus interest?
Carrier appeared and was represented by an (Attorney) by telephone. Respondent appeared and was represented by EL, lay representative. Claimant appeared and waived representation and assistance by an (Ombudsman).
The parties reached an agreement. The agreement only resolves the issue to be decided at this hearing. This agreement does not resolve all issues regarding the claim and is not a settlement.
In this decision, this Agreement section constitutes the findings of facts and the Decision section constitutes the conclusions of law.
- The parties stipulated to the following facts:
A.Venue is proper in the (City) Field Office of the Texas Department of Insurance, Division of Workers' Compensation.
B.On _________, Claimant was the employee of (Employer) when he sustained a compensable injury.
A.Carrier will pay Health Care Provider (Dr. SL) the amount of $863.03 plus interest.
Carrier will pay Health Care Provider (Dr. SL) the amount of $863.03 plus interest.
Under the terms of this agreement, Carrier is liable for the payment of the amount under the Medical Fee Dispute Resolution Findings and Decision (MR-04), Part VII, issued on February 11, 2008, totaling $863.03 plus interest..
The true corporate name of the insurance carrier is (SELF-INSURED) and the name and address of its registered agent for service of process is
(CITY), TEXAS (ZIP CODE)
Signed this 27th day of March, 2008.