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At a Glance:
Title:
453-02-0725-m5
Date:
February 15, 2002
Status:
Retrospective Medical Necessity

453-02-0725-m5

February 15, 2002

DECISION AND ORDER

American Safety Casualty Insurance Company (Petitioner) appealed the findings and decision in of the Texas Workers’ Compensation Insurance Commission’s (Commission) Medical Review Division in MDR docket M5-01-1736-01,which ordered Petitioner to pay reimbursement of $297.00 to JCMLR (Provider) for services or treatments provided to____ (Claimant). Petitioner provided proof that Claimant’s compensability claim had been denied and was no longer appealable. Compensability being a necessary for an appeal of this claim to the State Office of Administrative Hearings, this decision finds there is no appealable issue in this matter, which should be dismissed from the SOAH docket.

I. PROCEDURAL HISTORY, NOTICE AND JURISDICTION

Notice of the hearing was sent to all parties by the Chief Clerk of the Commission on November 13, 2001. The hearing in this matter was held January 14, 2002, at the Hearings Facility of the State Office of Administrative Hearings, Stephen F. Austin Building, Suite 1100, 1700 North Congress Avenue, Austin, Texas, with Administrative Law Judge (ALJ) Ann Landeros presiding. Petitioner appeared through its attorney, Gregory Solcher. Provider did not appear and was not represented. The Commission did not participate. The record closed that date.

II. DISCUSSION

Admitted into the record was Petitioner’s Exhibit 1, a copy of the Decision and Order in Texas Workers’ Compensation Commission Hearings Division docket number___ issued October 2, 2001, which found Claimant did not sustain an injury compensable under the Texas Worker’s Compensation Act. Exhibit 1 also contained a copy of the Commission’s appeal panel’s decision, filed November 21, 2001, which upheld the finding that Claimant’s injury was not compensable. There was no evidence that Claimant perfected any further appeals of her claim.

A worker’s claim for medical benefits under the Texas Labor Code is predicated upon the worker having sustained a compensable injury. TEX. LAB. CODE ANN §408.021(a). Because there is no evidence that Claimant sustained a compensable injury, any claim for medical benefits is moot and this appeal must be dismissed from the SOAH docket.

III. FINDINGS OF FACT

  1. Claimant, ____, did not suffer an injury compensable under the Texas Labor Code.
  2. American Safety Casualty Insurance Company (Petitioner) is not required to pay medical benefits for injuries to its insured’s employees unless the injuries are found to be compensable within the meaning of the Texas Labor Code.

IV. CONCLUSIONS OF LAW

  1. The Texas Workers’ Compensation Commission (Commission) has jurisdiction related to matters pursuant to the Texas Workers' Compensation Act (the Act), TEX. LABOR CODE ANN. § 413.031.
  2. The State Office of Administrative Hearings has jurisdiction over matters related to the hearings for medical benefits for injuries compensable under the Texas Labor Code, including the authority to issue a decision and order, pursuant to § 413.031(d) of the Act and TEX. GOV’T CODE ANN. ch. 2003.
  3. An employee who has sustained a compensable injury is entitled to all health care reasonably required by the nature of the injury as and when needed. The employee is specifically entitled to health care that cures or relieves the effects naturally resulting from the compensable injury, promotes recovery, or enhances the ability of the employee to return to or retain employment. TEX. LAB. CODE ANN. § 408.021(a).
  4. Based on the foregoing, there is no compensable injury at issue which could be the subject of an appeal to the State Office of Administrative Hearings, and this matter must be dismissed from the SOAH docket.

ORDER

IT IS ORDERED that matter be and is dismissed from the docket of the State Office of Administrative Hearings.

Signed this 15th day of February 2002.

ANN LANDEROS
Administrative Law Judge
STATE OFFICE OF ADMINISTRATIVE HEARINGS

End of Document
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