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At a Glance:
Title:
10171
Date:
May 3, 2010
Status:
Concurrent Medical Necessity

10171

May 3, 2010

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 May 3, 2010, to decide the following disputed issue:

Is the preponderance of the evidence contrary to the decision of the Independent Review Organization (IRO) that Claimant is not entitled to eight visits of physical therapy for treatment of the compensable left knee injury of ________________?

PARTIES PRESENT

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

Respondent/Carrier appeared, by telephone, and was represented by NM, adjuster.

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.
  2. On ________________, Claimant was the employee of (Employer) when he sustained a compensable left knee injury.
  3. 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:

The parties agree that the Claimant is entitled to two supervised sessions of physical therapy for instruction on a home exercise program for treatment of the compensable injury of ________________ and that the Claimant is not entitled to the other six requested sessions of physical therapy for treatment of the compensable left knee injury of ________________.

.

DECISION

Claimant is entitled to two visits of supervised physical therapy for instruction on a home exercise program for treatment of the compensable injury of ________________. The Claimant is not entitled to the other six sessions of physical therapy for treatment of the compensable injury of ________________.

ORDER

Carrier is 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 THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA and the name and address of its registered agent for service of process is:

CORPORATION SERVICE COMPANY

701 BRAZOS STREET, SUITE 1050

AUSTIN, TX 78701-3232

Signed this 3rd day of May, 2010.

Carol A. Fougerat
Hearing Officer

End of Document
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