DECISION AND ORDER

I. DISCUSSION

Howard Grant, M.D., (Petitioner) appealed the June 19, 2003 Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Ziroc, an Independent Review Organization (IRO), on June 18, 2003, denying reimbursement for services provided by Petitioner to injured worker ___ (Claimant) from October 8, 2002, through October 24, 2002.

The amount in dispute is $942.00. After considering the evidence and arguments of the parties, the Administrative Law Judge (ALJ) concludes that the services provided by Petitioner were not medically necessary.

The hearing convened on November 12, 2003, with State Office of Administrative Hearings (SOAH) ALJ Ruth Casarez presiding. Petitioner appeared pro se. Metropolitan Transit Authority of Houston (Respondent) appeared through its counsel, Steve Tipton. Petitioner testified on his own behalf. The hearing concluded and the record closed that day. Neither party objected to notice or jurisdiction. Subsequent to the record closing, the docket was reassigned to SOAH ALJ Howard S. Seitzman, who reviewed all of the evidence and the recording of the hearing on the merits.

Claimant suffered a work related injury on ___. On June 18 and 24, 2002, Claimant was examined by Gail Blakley, M.D., who diagnosed a left knee contusion. A July 2, 2002 MRI of the left knee revealed some indication of post-trauma inflammation but was otherwise unremarkable. Bruce R. Weiner, M.D., conducted a Required Medical Evaluation (RME) on October 14, 2002. Dr. Weiner’s October 21, 2002 report notes that although Claimant has undergone therapy for more than four months, none of the therapy has involved exercise. As Dr. Weiner noted and as Dr. Grant testified, all of the therapy was passive, such as ultrasound, massage and hot/cold packs. Dr. Weiner also remarked that there was confusion among the treating and consulting doctors.^[1] Dr. Weiner concluded that Claimant had no serious knee condition. On January 15, 2003, Claimant had surgery on her left knee. The arthroscopic surgery revealed some mild chondromalacia and no significant meniscal tear.

The only issue in this proceeding is whether the services provided by Petitioner to Claimant from October 8, 2002, through October 24, 2002, were medically necessary. Petitioner had the burden of proof. Petitioner failed to prove that the services were medically necessary. Petitioner’s medical records reflect that Claimant’s symptomology prior to and after October 8, 2002, was unchanged and that her condition likewise remain unchanged. The daily progress notes are all identical.

Consequently, Petitioner failed to demonstrate by a preponderance of the evidence that the services provided Claimant between October 8, 2002, and October 24, 2002, were medically necessary. Petitioner is not entitled to reimbursement for services provided Claimant between October 8, 2002, and October 24, 2002.

II. FINDINGS OF FACT

1. ___ (Claimant) suffered a work related injury on ___.
2. On June 18 and 24, 2002, Claimant was examined by Gail Blakley, M.D., and diagnosed with a left knee contusion.
3. A July 2, 2002 MRI of the left knee revealed some indication of post-trauma inflammation but was otherwise unremarkable.
4. Bruce R. Weiner, M.D., conducted a Required Medical Evaluation (RME) on October 14, 2002.
5. Claimant underwent physical therapy with Howard Grant, M.D., (Petitioner) for more than four months, but none of the therapy involved exercise of the left knee.
6. Claimant received only passive therapy.
7. On January 15, 2003, Claimant had surgery on her left knee. The arthroscopic surgery revealed some mild chondromalacia and no significant meniscal tear.
8. Claimant has no serious condition involving her knee.
9. The treatment dates in issue are October 8, 9, 10, 15, 16, 17, 21, 22, 23, and 24, 2002.
10. Metropolitan Transit Authority of Houston (Respondent) denied Petitioner reimbursement for the services provided Claimant between October 8, 2002, and October 24, 2002, as not medically necessary.
11. The Texas Workers’ Compensation Commission (Commission), acting through an Independent Review Organization (IRO), Ziroc, found that the services provided by Petitioner between October 8, 2002, and October 24, 2002, were not medically necessary for the treatment of Claimant.
12. Petitioner timely requested a hearing before the State Office of Administrative Hearings (SOAH).
13. The hearing convened on November 12, 2003, with SOAH Administrative Law Judge (ALJ) Ruth Casarez presiding. Petitioner appeared pro se. Respondent appeared through its counsel, Steve Tipton. The hearing concluded and the record closed that day.
14. Subsequent to the record closing, the docket was reassigned to SOAH ALJ Howard S. Seitzman who reviewed all of the evidence and the recording of the hearing on the merits.
15. The amount in dispute is $942.00.

III. CONCLUSIONS OF LAW

1. SOAH has jurisdiction over this proceeding, including the authority to issue a decision and order, pursuant to the Texas Workers’ Compensation Act, specifically Tex. Labor Code Ann. §413.031(k), and Tex. Gov’t Code Ann. ch. 2003.
2. The hearing was conducted pursuant to the Administrative Procedure Act, Tex. Gov’t Code Ann. ch. 2001 and 28 Tex. Admin. Code ch. 148.
3. The request for a hearing was timely made pursuant to 28 Tex. Admin. Code § 148.3.
4. Adequate and timely notice of the hearing was provided according to Tex. Gov’t Code Ann. §§ 2001.051 and 2001.052.
5. Petitioner has the burden of proof in this matter. 28 Tex. Admin. Code §§ 148.21(h) and 133.308(w).
6. Petitioner failed to prove by a preponderance of the evidence that the services provided to Claimant from October 8, 2002, through October 24, 2002, were medically necessary.

ORDER

THEREFORE IT IS ORDERED that Howard Grant, M.D., is not entitled to reimbursement from Metropolitan Transit Authority of Houston for charges associated with services provided to injured worker ___ from October 8, 2002, through October 24, 2002.

Signed January 11, 2004.

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

1. ¹ The medical records in this docket are atrocious. The date of injury is incorrect on more than one occasion. Although Claimant injured her left knee, the surgeon diagnosed a right knee injury and indicated he planned to schedule arthroscopic surgery on the right knee.↑