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 convened on November 15, 2011, with the record closing on January 31, 2012, to decide the following disputed issue:

Is the preponderance of the evidence contrary to the decision of the Independent Review Organization (IRO) that the Claimant is not entitled to open reduction internal fixation (ORIF) with bone graft, manipulation under anesthesia (MUA), arthroscopy, lysis of adhesions, CPT 23485 (revision of collar bone), and CPT 29826 (shoulder arthroscopy) for the compensable injury of (Date of Injury)?

PARTIES PRESENT

Petitioner/Provider, Dr. B, appeared by telephone. Claimant personally appeared and was represented by LT, attorney. Respondent/Carrier appeared and was represented by SC, attorney.

AGREEMENT

The parties reached an agreement. The agreement resolves only the issue 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 conclusions of law.

Including stipulations entered into on November 15, 2011, and the written agreement signed by the parties and admitted into in the record, the parties agreed as follows:

1. Venue is proper in the Houston West Field Office of the Texas Department of Insurance, Division of Workers’ Compensation.
2. On (Date of Injury), Claimant was the employee of (Employer), Employer.
3. On (Date of Injury), Employer provided workers’ compensation insurance with Standard Fire Insurance Company, Carrier.
4. On (Date of Injury), the Claimant sustained a compensable left shoulder and left clavicle injury while in the course and scope of her employment with (Employer).
5. The proposed ORIF with bone graft/revision of collar bone is health care reasonably necessary for the compensable injury of (Date of Injury).
6. The proposed MUA, arthroscopy and lysis of adhesions are not health care reasonably necessary for the compensable injury of (Date of Injury).
7. DECISION

An ORIF with bone graft/revision of collar bone is reasonably required health care for the compensable injury of (Date of Injury). MUA, arthroscopy and lysis of adhesions are not reasonably required health care for the compensable injury of (Date of Injury).

ORDER

Carrier is ORDERED to pay medical benefits in accordance with this decision, the Act and the implementing Rules.

The true corporate name of the insurance carrier is STANDARD FIRE INSURANCE COMPANY, and the name and address of its registered agent for service of process is

CORPORATION SERVICE COMPANY d/b/a CSC-LAWYERS INCORPORATING SERVICE COMPANY

211 EAST 7TH STREET, STE. 620

AUSTIN, TX 78701-3218

Signed this 31st day of January, 2012.

Patrice Fleming-Squirewell
Hearing Officer