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At a Glance:
Title:
13057-nnr
Date:
February 5, 2013

13057-nnr

February 5, 2013

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 February 4, 2013, 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 entitled to a self-suspended partial right hand and myoelectric prosthesis with independently articulating fingers for the compensable injury of (Date of Injury)?

PARTIES PRESENT

Petitioner/Carrier appeared and was represented by AA, attorney. Claimant appeared and was assisted by MP, ombudsman. In attendance on behalf of Respondent was RD, clinical care provider.

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 parties agreed as follows:

  1. Venue is proper in the (City) 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 had workers’ compensation insurance with New Hampshire Insurance Company, Carrier.
  4. Claimant sustained a compensable right hand index, middle, and ring finger injury on (Date of Injury).
  5. The IRO determined that Claimant is entitled to a self-suspended partial right hand and myoelectric prosthesis with independently articulating fingers for the compensable injury of (Date of Injury).
  6. 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 2A.
  7. Carrier delivered to Respondent 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 2B.
  8. The preponderance of the evidence is not contrary to the determination of the IRO that Claimant is entitled to a self-suspended partial right hand and myoelectric prosthesis with independently articulating fingers for the compensable injury of (Date of Injury).

DECISION

Claimant is entitled to a self-suspended partial right hand and myoelectric prosthesis with independently articulating fingers for the compensable injury of (Date of Injury).

ORDER

Carrier is liable for the benefits at issue in this hearing. Claimant remains entitled to medical benefits for the compensable injury of (Date of Injury), in accordance with Texas Labor Code Ann. §408.021.

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

CORPORATION SERVICE COMPANY

211 EAST 7TH STREET, SUITE 620

AUSTIN, TEXAS 78701-3218

Signed this 5th day of February, 2013.

Wes Peyton
Hearing Officer

End of Document
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