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At a Glance:
Title:
08086-m4r
Date:
July 11, 2008

08086-m4r

July 11, 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 contested case hearing was docketed for 06/18/08 and, at the request of the Parties, held on 07/11/08, to decide the following disputed issue:

  1. Is the Respondent entitled to reimbursement in the amount of $464.00

plus applicable accrued interest, for services rendered to the Claimant

on 03/21/07 or 10/15/07?

PARTIES PRESENT

Petitioner and was represented by RT, attorney. Respondent was represented by JE, lay representative.

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:

  1. Venue is proper in the (City) Field Office of the Texas Department of Insurance,

Division of Workers’ Compensation.

  • On ________, Claimant was the employee of the (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:

    1. Respondent is not entitled to reimbursement in the amount of $464.00,

    plus applicable accrued interest, for services rendered to the Claimant

    on 03/21/07 or 10/15/07.

    DECISION

    Respondent is not entitled to reimbursement in the amount of $464.00, plus

    applicable accrued interest, for services rendered to the Claimant on 03/21/07 or

    10/15/07?

    ORDER

    Petitioner is not liable for the benefits at issue in this hearing. Claimant remains entitled to medical benefits for the compensable injury in accordance with §408.021.

    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:

    EXECUTIVE DIRECTOR

    (ADDRESS)

    (CITY), TEXAS (ZIP CODE)

    Signed this 11th day of July, 2008.

    G. W. Quick

    Hearings Officer

    End of Document
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