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At a Glance:
Title:
10086
Date:
December 21, 2009
Status:
Concurrent Medical Necessity

10086

December 21, 2009

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 contested case hearing was held on December 21, 2009, to decide the following disputed issue:

  1. Is the preponderance of the evidence contrary to the decision of the IRO that the claimant is not entitled to an EMG/NCV for the compensable injury of __________?

PARTIES PRESENT

Petitioner/Claimant appeared and was assisted by DM, ombudsman.

Respondent/Carrier appeared by telephone and was represented by HF, attorney.

AGREEMENT

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

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

The Hearing Officer found:

A.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.

The parties agreed as follows:

  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 of the Texas Department of Insurance.
  3. On __________, Claimant was the employee of Texas Department of Transportation,

Employer, and sustained a compensable injury.

  • The Independent Review Organization determined Claimant should not have an
  • EMG/NCV.

  • The EMG/NCV requested by Dr. M is the first such individual diagnostic
  • study requested, and is not subject to the preauthorization rules set out in Division

    Rule 134.600 (p).

  • Claimant is entitled to an EMG/NCV for the compensable injury of __________.
  • DECISION

    Claimant is entitled to an EMG/NCV 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.

    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

    AS, JR., P.E.

    EXECUTIVE DIRECTOR

    (SELF-INSURED)

    (STREET ADDRESS)

    (CITY), TEXAS (ZIP CODE)

    Signed this 21st day of December, 2009

    Cheryl Dean
    Hearing Officer

    End of Document
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