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At a Glance:
Title:
08088-m4r
Date:
July 8, 2008

08088-m4r

July 8, 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 held on 06/12/08, with the Record closed on 06/17/08, to decide the following disputed issue:

  1. Is Carrier in compliance with the Medical Dispute Order to pay

(Health Care Provider) $777.12 for services rendered to the Claimant for dates of

service 03/26/07 through 03/28/07?

PARTIES PRESENT

Claimant's appearance was waived. Petitioner appeared and was represented by CK, attorney. Respondent appeared by phone and was represented by JE, attorney.

BACKGROUND INFORMATION

It is undisputed the Claimant was injured in the course and scope of her employment on _______. It is also undisputed the Respondent, (Health Care Provider), provided benefits to the Claimant on 03/26/07 through 03/28/07. The bill for this treatment was properly submitted. The Carrier, Petitioner, submitted exhibits, in the form of payment summaries, reflecting the bills had been paid in a timely manner. These bills were paid by the Carrier before Medical Review entered the Order to pay. The Respondent acknowledged receipt of the payments. The Carrier is in compliance with the Order from Medical Review.

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 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).

  • Carrier delivered to Claimant a single document stating the true corporate name of Carrier, and the name and street address of Carrier’s registered agent, which document was admitted into evidence as Hearing Officer’s Exhibit Number 2.
  • Petitioner timely paid Respondent $777.12 for dates of service: 3/26/07 through 3/28/07.
  • Petitioner is in compliance with the Medical Fee Dispute resolution Findings and Decision.
  • CONCLUSIONS OF LAW

    1. The Texas Department of Insurance, Division of Workers’ Compensation, has jurisdiction to hear this case.
    2. Venue is proper in the (City) Field Office.
    3. Carrier is in compliance with the Medical Dispute Order to pay (Health Care Provider)

    $ 777.12 for services rendered to the Claimant for dates of service

    03/26/07 through 03/28/07?

    DECISION

    Carrier in compliance with the Medical Dispute Order to pay (Health Care Provider) $777.12

    for services rendered to the Claimant for dates of service 03/26/07 through

    3/28/07?

    ORDER

    Carrier has paid 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 XL SPECIALTY INSURANCE COMPANY and the name and address of its registered agent for service of process is:

    KIRK HOOD

    1021 MAIN STREET, SUITE 1150

    HOUSTON, TX 77002-6508

    Signed this 8th day of July, 2008.

    G. W. Quick

    Hearings Officer

    End of Document
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