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At a Glance:
Title:
09032
Date:
September 12, 2008
Status:
Medical Fees

09032

September 12, 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.

ISSUES

A pre-hearing medical fee dispute was scheduled to be held on September 12,

2008. At the September 12, 2008, pre-hearing, both Petitioner/Subclaimant and

Respondent/Carrier entered into an agreement on the record with respect to

the fee dispute for dates of service June 18, 2007, and June 25, 2007.

PARTIES PRESENT

Petitioner/Subclaimant appeared by telephone and was represented by JW. Respondent/Carrier appeared by telephone and was represented by BJ, 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:

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

Division of Workers’ Compensation.

  • On ________, Claimant was an employee of (Employer), and
  • sustained a compensable injury.

    The Parties agreed to the following:

    1. To withdraw the disputed issue of “Whether the preponderance of the evidence is

    contrary to the decision of Medical Review that the UB-92 was not submitted

    timely in accordance with Section 408.027(a) which provides that a health care

    provider shall submit a claim for payment to the insurance carrier not later than the

    95th day after the date on which the health care services are provided to the injured

    employee, and since there was not a timely filing the Petitioner has forfeited the

    right to reimbursement;” and

  • Texas Mutual Insurance Company/Respondent/Carrier agrees to pay to Petitioner/
  • Subclaimant/(Health Care Provider) the Maximum Allowable Reimbursement

    (MAR) in the amount of $472.38 for dates of service of June 18, 2007, and June 25,

    2007.

    DECISION

    Texas Mutual Insurance Company/Respondent/Carrier agrees to pay to Petitioner/Sub-claimant/(Health Care Provider)the Maximum Allowable Reimbursement (MAR) in the amount of $472.38 for dates of service of June 18, 2007, and June 25, 2007.

    ORDER

    Carrier/Respondent is ordered to pay benefits in accordance with this decision, the Texas

    Workers’ Compensation Act and the Commissioner’s Rules.

    The true corporate name of the insurance carrier is TEXAS MUTUAL INSURANCE

    COMPANY, and the name and address of its registered agent for service of process is:

    RUSSELL OLIVER, PRESIDENT

    TEXAS MUTUAL INSURANCE COMPANY

    6210 EAST HIGHWAY 290

    AUSTIN, TEXAS 78723

    Signed this 12th day of September 2008

    Cheryl Dean
    Hearing Officer

    End of Document
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