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 October 16, 2012 to decide the following disputed issue:

Is the preponderance of the evidence contrary to the decision of Medical Fee Dispute Resolution that Claimant is not entitled to reimbursement in the amount of $1,340.00 for medical services rendered between June 10, 2009 through July 7, 2009 for the compensable injury of (Date of Injury)?

PARTIES PRESENT

Claimant appeared and was assisted by AF, ombudsman.

Carrier appeared and was represented by WS, 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 conclusions of law.

The Hearing Officer found:

1. 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.
2. The Texas Department of Insurance, Division of Workers’ Compensation, has jurisdiction to hear this case.
3. Venue is proper in the (City) Field Office of the Texas Department of Insurance, Division of Workers’ Compensation.
4. On (Date of Injury), Claimant was the employee of (Employer), Employer.
5. On (Date of Injury), Employer provided workers’ compensation insurance with Ace American Insurance Company, Carrier.

The parties agreed as follows:

Claimant is entitled to reimbursement in the amount of $1,340.00 for medical services rendered between June 10, 2009 through July 7, 2009 for the compensable injury of (Date of Injury).

DECISION

Claimant is entitled to reimbursement in the amount of $1,340.00 for medical services rendered between June 10, 2009 through July 7, 2009 for the compensable injury of (Date of Injury).

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 ACE AMERICAN INSURANCE COMPANY and the name and address of its registered agent for service of process is:

CT CORPORATION SYSTEM

350 NORTH ST. PAUL STREET

DALLAS, TX 75201

Signed this 19th day of October, 2012.

Donald E. Woods
Hearing Officer