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At a Glance:
Title:
16015-nnr
Date:
February 25, 2016

16015-nnr

February 25, 2016

DECISION AND ORDER

This case is decided pursuant to Chapter 410 of the Texas Workers’ Compensation Act and the Rules of the Texas Department of Insurance, Division of Workers’ Compensation. In accordance with the parties agreement discussed herein, the Hearing Officer determines that the Claimant is entitled to 1 magnetic resonance imaging [MRI] on bilateral lumbar spine without contrast.

STATEMENT OF THE CASE

On February 16, 2016, Jacqueline Harrison, a Division hearing officer, held a contested case hearing to decide the following disputed issue:

  1. Is the preponderance of the evidence contrary to the decision of the Independent Review Organization (IRO) that the Claimant is not entitled 1 magnetic resonance imaging [MRI] on bilateral spine without contrast for the compensable injury of (Date of Injury)?

PARTIES PRESENT

Petitioner/Claimant appeared and was assisted by RE, ombudsman. Respondent/Carrier appeared and was represented by CK, 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 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 provided workers’ compensation insurance with New Hampshire Insurance Company, Carrier.
  4. On (Date of Injury), Claimant sustained a compensable injury.
  5. 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.
  6. Claimant is entitled to 1 magnetic resonance imaging [MRI] on bilateral lumbar spine without contrast.

DECISION

Claimant is entitled to 1 magnetic resonance imaging [MRI] on bilateral lumbar spine without contrast.

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 NEW HAMPSHIRE INSURANCE COMPANY and the name and address of its registered agent for service of process is:

CORPORATION SERVICE COMPANY

211 EAST 7TH ST., STE. 620

AUSTIN, TX 78701-3218

Signed this 25th day of February, 2016.

Jacqueline Harrison
Hearing Officer

End of Document
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