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At a Glance:
Title:
453-02-0780-c1
Date:
October 15, 2002
Status:
Compliance

453-02-0780-c1

October 15, 2002

DECISION AND ORDER

The Texas Workers’ Compensation Commission (Commission) alleged _______filed fraudulent mileage statements with Crawford & Company/National Union Fire Insurance Company resulting in the overpayment of $672.20 in workers’ compensation mileage benefits for the period January 1999 through August 2000. The Commission seeks an administrative penalty of $250.00 and a refund to Crawford & Company/National Union Fire Insurance Company of $672.20 plus interest in accordance with §415.008(c) of the Texas Labor Code.

The Commission had the burden of proof by a preponderance of the evidence. The Administrative Law Judge (ALJ) concludes _________ filed fraudulent mileage statements with Crawford & Company/National Union Fire Insurance Company resulting in the overpayment of at least $672.20 in workers’ compensation mileage benefits. Therefore, the ALJ orders __________to refund $672.20 plus interest to Crawford & Company/National Union Fire Insurance Company in accordance with §415.008(c) of the Texas Labor Code and to pay an administrative penalty of $250.00 to the Commission.

The Commission appeared at the September 23, 2002 hearing on the merits through its counsel, Ms. Yvonne Williams. ________ failed to appear either in person or through counsel.

I. Findings of Fact

  1. ______ suffered a compensable injury on or about______.
  2. A treating professional ordered a health club membership and Crawford & Company/National Union Fire Insurance Company (Carrier) paid for the membership at the Huguley Fitness Center (Fitness Center).
  3. ______ filed, on a monthly basis, mileage reimbursement requests for daily travel to the Fitness Center to participate in prescribed activities.
  4. The monthly mileage reimbursement requests contained the initials ____ verifying _______ attendance at the Fitness Center.
  5. Although the initials ____ were purported to be those of________, __________did not initial the documents.
  6. ________ did not attend activities at the Fitness Center for all of the days specified in the monthly mileage reimbursement requests.
  7. ________ knowingly and intentionally filed falsified monthly mileage reimbursement requests for the period January 1999 through August 2000.
  8. Carrier, unaware of the falsified records, paid ________ the full amounts she requested for travel during the period January 1999 through August 2000.
  9. As a result of _______ filing falsified records, the Carrier overpaid _______ by at least $672.20 for workers’ compensation mileage benefits.
  10. On March 29, 2001, the Texas Workers’ Compensation Commission (Commission) issued a Notice of Administrative Violation(s) and Order to Respond (Notice of Violation) to ____.
  11. On August 2, 2001, the Commission resent the Notice of Violation to________.
  12. ______ filed a request for a hearing before the State Office of Administrative Hearings (SOAH).
  13. The Commission stipulated _____ request for a SOAH hearing was timely filed.
  14. Notice of the SOAH hearing was sent November 19, 2001, and received by _______ on November 21, 2001.
  15. The one-day hearing convened on September 23, 2002, with Administrative Law Judge Howard S. Seitzman presiding.
  16. Ms. Yvonne Williams, represented the Commission at the September 23, 200 hearing while _______ failed to appear either in person or through counsel.
  17. The record closed on September 23, 2002.

II. Conclusions of Law

  1. The Commission has jurisdiction over this matter pursuant to Section 415.008 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. §415.034 and Tex. Gov’t Code Ann. ch. 2003.
  3. Adequate and timely notice of the hearing was provided in accordance with Tex. Gov’t Code Ann. §2001.052.
  4. The Commission had the burden of proof in this matter pursuant to 28 Tex. Admin. Code §148.21(h).
  5. ________ received reimbursement for workers’ compensation mileage benefits to which she was not entitled.
  6. _________ violated §415.008(a) of the Act by filing falsified monthly mileage reimbursement requests for the period January 1999 through August 2000.
  7. The $250.00 administrative penalty complies with §415.021 of the Act.
  8. Pursuant to §415.008(c) of the Act, _________ is required to make full repayment of the excess mileage reimbursement she received.
  9. Pursuant to §415.008(c) of the Act, _______ shall pay interest computed at the rate prescribed in §401.023 of the Act.

ORDER

THEREFOREIT IS ORDERED that _______ pay Crawford & Company/National Union Fire Insurance Company the sum of $672.20 plus applicable interest for excess workers’ compensation mileage benefits received by her. IT IS FURTHER ORDERED that _______ pay an administrative penalty in the amount of $250.00 to the Texas Workers’ Compensation Commission. ________ shall pay all sums required by this Order by not later than 30 days from the date she receives this Order.

Signed AT AUSTIN, TEXAS the 15th day of October, 2002.

HOWARD S. SEITZMAN
Administrative Law Judge
STATE OFFICE OF ADMINISTRATIVE HEARINGS

End of Document
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