454-18-3509-m4-np
DECISION AND ORDER This case involves a dispute regarding payment for medical services provided by Healthcare Provider (HCP) to an injured employee (Claimant) covered by the worker’s compensation insurance system. The Texas Department of Insurance’s Division of Worker’s Compensation (Division) conducted a medical fee dispute resolution (MFDR) and declined to order Carrier to reimburse HCP […]
454-18-3077-m4-np
DECISION AND ORDER Carrier challenges the Medical Fee Dispute Findings and Decision (MFD Decision) issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division). The MFD Decision ordered Carrier to reimburse Healthcare Provider (Provider) the additional sum of $4,579.70 for implantables used by Provider during outpatient surgery performed on an injured worker (Claimant). […]
454-18-2555-m4-np
MODIFIED DECISION AND ORDER FOLLOWING GRANT OF MOTION FOR REHEARING This case involves urine drug testing ordered by Healthcare Provider (HCP) for an injured employee covered by the workers’ compensation insurance system. The Texas Department of Insurance’s Division of Workers’ Compensation (Division) conducted medical fee dispute resolution (MFDR) and declined to order Carrier to reimburse […]
454-18-2561-m4-np
DECISION AND ORDER This case involves services rendered by Health Care Provider(HCP) to an injured person covered by the workers’ compensation insurance system. The Texas Department of Insurance’s Division of Workers’ Compensation (Division) conducted medical fee dispute resolution (MFDR) and Carrier to reimburse HCP in the amount of $335.48.[1] HCP contends it is entitled to […]
454-18-0969-m4-np
DECISION AND ORDER This case involves services rendered by (Healthcare Provider) (HCP) to an injured employee covered by the workers’ compensation insurance system. The Texas Department of Insurance’s Division of Workers’ Compensation (Division) conducted medical fee dispute resolution (MFDR) and declined to order (Carrier) to reimburse (HCP) in the amount of $13,905.00.[1] The Administrative Law […]
454-17-5716-m4-np
DECISION AND ORDER (Carrier) sought a contested case hearing regarding a Medical Fee Dispute Resolution Findings and Decision (MDR Decision) issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division). The MDR Decision ordered Carrier to reimburse (Healthcare Provider) (Provider) $1,570.66 for services provided to an injured worker. Carrier appeals the MDR Decision […]
454-17-4926-m4-np
DECISION AND ORDER This case involves a claim for reimbursement of amounts billed for implantable surgical devices (implantables) used in a June 24, 2016 surgery on an injured worker. (Insurance Company) paid $31,589.53 of the amounts billed. In a medical fee dispute resolution (MFDR) before the Texas Department of Insurance Division of Workers Compensation (Division), […]
454-17-4371-m4-np
DECISION AND ORDER This case involves services rendered by WDS, M.D. to an injured employee covered by the workers’ compensation insurance system. The Texas Department of Insurance’s Division of Workers’ Compensation (Division) conducted medical fee dispute resolution (MFDR) and declined to order Carrier to reimburse Dr. S in the amount of $431.49. The Administrative Law […]
454-17-4188-m4-np
DECISION AND ORDER Injured worker R.G.W. challenges the Medical Fee Dispute Findings and Decision of the Texas Department of Insurance, Division of Worker’s Compensation (Division or DWC) that (Carrier) is not required to reimburse him $3,000 for the purchase of a full body massage chair that was not preauthorized by Carrier. The Administrative Law Judge […]
454-17-1460-m4-np
DECISION AND ORDER ______ (Millennium) challenges a decision of the Texas Department of Insurance, Division of Workers’ Compensation that denied its request for reimbursement for six functional capacity evaluations (FCEs) billed to Twin City Fire Insurance Co. (Twin City). On January 24, 2017, Twin City filed a Motion for Summary Disposition. On February 20, 2017, […]