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 medical contested case pre-hearing was held on February 22, 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 not entitled to radiofrequency lesioning, right SI joint L5, Rs1, Rs2, Rs3 for the compensable injury of (Date of Injury)?

PARTIES PRESENT

Claimant/Petitioner failed to appear for the pre-hearing and did not respond to the Division’s 10-day letter. Carrier/Respondent appeared and was represented by attorney BS.

BACKGROUND INFORMATION

Although properly notified, the Claimant failed to appear for the medical contested case pre-hearing scheduled for 2:00 p.m. on February 22, 2013. By virtue of Claimant’s failure to appear, evidence was presented at that proceeding. A letter advising that the pre-hearing had convened and that the record would be held open for ten days to afford Claimant the opportunity to respond and request that the pre-hearing be rescheduled to permit him to present evidence on the disputed issue was mailed to Claimant on February 26, 2013. Claimant failed to respond to the Division’s 10-day letter and on March 11, 2013, the record was closed.

Having failed to appear and offer evidence in support of the medical necessity of the requested procedure, Claimant failed to prove that the preponderance of the medical evidence is contrary to the determination of the IRO that he is not entitled to radiofrequency lesioning, right SI joint L5, Rs1, Rs2, Rs3 for the compensable injury of (Date of Injury).

Even though all the evidence presented was not discussed, it was considered. The Findings of Fact and Conclusions of Law are based upon all of the evidence presented and admitted.

FINDINGS OF FACT

1. The Carrier admitted to the following facts:
   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), and sustained a compensable injury.
   3. On (Date of Injury), Employer provided workers’ compensation insurance as a Self-Insured.
   4. The Independent Review Organization (IRO) determined that the health care at issue in this case is not reasonably required for the compensable injury of (Date of Injury).
2. The Division sent a single document stating the true corporate name of the Carrier and the name and street address of Carrier’s registered agent for service with the 10-day letter to the Claimant at Claimant’s address of record. That document was admitted into evidence as Hearing Officer Exhibit Number 2.
3. Claimant failed to appear for the February 22, 2013, medical contested case pre-hearing, and did not respond to the Division’s 10-day letter offering him the opportunity to have the hearing rescheduled.
4. Radiofrequency lesioning, right SI joint L5, Rs1, Rs2, Rs3 is not health care reasonably required for the compensable injury of (Date of Injury).

CONCLUSIONS OF LAW

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.
3. The preponderance of the evidence is not contrary to the decision of the IRO that Claimant is not entitled to radiofrequency lesioning, right SI joint L5, Rs1, Rs2, Rs3 for the compensable injury of (Date of Injury).

DECISION

Claimant is not entitled to radiofrequency lesioning, right SI joint L5, Rs1, Rs2, Rs3 for the compensable injury of (Date of Injury).

ORDER

Carrier is not liable for the benefits at issue in this hearing, and it is so ordered. Claimant remains entitled to medical benefits for the compensable injury in accordance with §408.021.

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:

(NAME)

(TELEPHONE)

(ADDRESS)

(CITY), (STATE)

CCS CONSULTING

THIRD PARTY ADMINISTRATOR

Signed this 11^th day of March, 2013

Cheryl Dean
Hearing Officer