DECISION AND ORDER

Transcontinental Insurance Company (Petitioner) has appealed the decision of the Texas Workers Compensation Commission’s Medical Review Division (MRD) ordering payment to The Back and Joint Clinic for medical services provided to____ from June 9, 1999, through March 10, 2000. In this decision, the Administrative Law Judge finds that Petitioner has shown that the medical services provided after September 29, 1999, were not reasonable and necessary to treat the compensable injury. Petitioner is ordered to reimburse the reasonable and necessary costs associated with treatment from June 9, 1999, until September 28, 1999.

I. Discussion

It is uncontroverted that_____ suffered a compensable injury, an electrical burn to his left hand, on ______. Petitioner argues that services provided after June 25, 1999, were not reasonable and necessary. In support of its position, Petitioner relies on the medical examinations performed by Dr. Richard H. Conklin, M.D., Ph.D. and Dr. Todd L Bear, D.C., as well as the expert opinions of Dr. Samuel Bierner, who reviewed the patient’s medical records and testified during the hearing. Respondent Back and Joint Clinic maintains, however, that all treatments were reasonable and necessary and in support of its position relies on the medical records as well as the testimony and expert opinions of Dr. David N. Bailey, D.C., F.A.C.O.

After reviewing the evidentiary record, the ALJ finds that the preponderance of the evidence suggests the medical services provided after September 29, 1999, were not reasonable and necessary to treat the compensable injury. On the date of his examination of M.S., September 29, 1999, Dr. Conklin, the independent examiner, found “0 % impairment” and noted that the patient had certainly reached maximum medical improvement (MMI). The designated doctor, Dr. Bear, examined the patient on November 16, 1999, and concurred with Dr. Conklin’s assessment of “0 % impairment.” Dr. Bear added that M.S. had fully recovered physically and would fully recover mentally after returning to work. After reviewing the medical records offered into the record, Dr. Bierner opined on behalf of Petitioner that no therapy, other than that performed at home, should have been required after June 25, 1999. He noted that there was no evidence of nerve or spinal damage, that the cardiac exam and EMG tests were normal and that the patient’s indication of widespread tenderness, almost everywhere the doctor touched, suggested psychological causes.

Based on the above evidence, the ALJ concludes that Petitioner met its burden of proving that treatment after September 29, 1999, was not reasonable and necessary. While Dr. Bailey argued that M.S. showed physical improvement including an increase in strength as a result of the work hardening program, this does not establish that there was any impairment related to the compensable injury at the time the work hardening program began, October 21, 1999.

II. FINDINGS of Fact

1. _____ sustained a compensable work-related injury on ______, at which time his employer’s workers compensation carrier was Transcontinental Insurance Company (Carrier).
2. As a result of the compensable injury,_____ suffered minor burns to his left hand.
3. The Back and Joint Clinic (Provider) treated____ from June 9, 1999, until March 10, 2000, and billed Carrier approximately $29,000 for this medical treatment.
4. By September 29, 1999,.____ had a zero percent total body impairment and had reached maximum medical improvement.
5. An independent examiner, Dr. Richard H. Conklin, M.D., Ph.D., examined _____on September 29, 1999, and assessed his current total body impairment at zero percent and believed MMI was reached on May 28, 1999 and certainly by September 29, 1999.
6. A designated doctor, Dr. Todd L. Bear, D.C., examined ____on November 16, 1999 and assessed his impairment at zero percent, adding that ____ had fully recovered physically.
7. A cardiac evaluation as well as an EMG and nerve conduction test were normal.
8. At the time of the review by the independent examiner and designated doctor, there was no evidence of nerve damage, intrinsic spinal damage or disc herniation and no deficiencies in range of motion or strength. After the first month subsequent to the injury, there was no evidence in the medical records that something was wrong other than the widespread complaint of tenderness, which is most likely related to anxiety.
9. Carrier denied reimbursement, arguing that the services were not reasonably related to the compensable injury.
10. Provider filed a Request for Medical Dispute Resolution with the Texas Workers’ Compensation Commission’s Medical Review Division (MRD), seeking reimbursement for the unreimbursed treatment of M.S.
11. On November 17, 2000, the MRD determined that Provider was entitled to reimbursement in the amount of $11,547.93.
12. On December 8, 2000, Carrier filed a request for hearing before the State Office of Administrative Hearings.
13. Notice of the hearing was sent on January 5, 2001.
14. The notice contained a statement of the time, place, and nature of the hearing; a statement of the legal authority and jurisdiction under which the hearing was to be held; a reference to the particular sections of the statutes and rules involved; and a short, plain statement of the matters asserted.
15. After several continuances were granted, the hearing was held on February 26, 2002, with Administrative Law Judge Tommy L. Broyles presiding and representatives of the Carrier and Provider participating. The hearing was adjourned and the record closed that same day.

III. CONCLUSIONS of Law

1. The Commission has jurisdiction over this matter pursuant to Section 413.031 of the Texas Workers’ Compensation Act (the Act), Tex. Lab. Code Ann. ch. 401 et seq.
2. SOAH has jurisdiction over this proceeding, including the authority to issue a decision and order, pursuant to Tex. Lab. Code Ann. §413.031(d) and Tex. Gov’t Code Ann. ch. 2003.
3. Petitioner timely filed its notice of appeal, as specified in 28 Tex. Admin. Code § 148.3.
4. Proper and timely notice of the hearing was effected upon the parties according to Tex. Gov’t Code § 2001.052 and 28 Tex. Admin. Code §148.4.
5. Carrier had the burden of proof on its appeal by a preponderance of the evidence, pursuant to Tex. Lab. Code Ann. § 413.031 and 28 Tex. Admin. Code §148.21(h).
6. The amount ordered reimbursed by MRD for treatment from June 9, 1999 until September 28, 1999, was reasonable and necessary to treat the compensable injury. Provider is entitled to reimbursement in the total amount of $2,109.33 for this treatment. Tex. Lab. Code Ann. § 408.021.
7. The amount ordered reimbursed by MRD for treatment from September 29, 1999 until March 10, 2000 was not reasonable and necessary to treat the compensable injury; therefore, Provider is not entitled to reimbursement for this treatment in the amount of $9,149.60. Tex. Lab. Code Ann. § 408.021.

ORDER

IT IS ORDERED THAT the appeal by Transcontinental Insurance Company is GRANTED in part. Transcontinental Insurance Company is ordered to pay the sum of $2,109.33 to The Back and Joint Clinic pursuant to this order.

Signed April 17, 2002.

STATE OFFICE OF ADMINISTRATIVE HEARINGS

TOMMY L. BROYLES
Administrative Law Judge