454-17-0687-m4-np
DECISION AND ORDER Texas Mutual Insurance Company (TMIC) challenges a decision of the Texas Department of Insurance, Division of Workers’ Compensation (Division) holding that TMIC is liable for a medical bill from Medspring Urgent Care (Medspring) associated with the treatment of an injured worker. On November 16, 2016, TMIC filed a Motion for Summary Disposition […]
454-16-4910-m4-np
DECISION AND ORDER Old Republic Insurance Company (Old Republic) challenges a decision of the Texas Department of Insurance, Division of Workers’ Compensation (Division) that awarded Memorial Compounding Pharmacy (Memorial) reimbursement for a compound topical cream prepared by Memorial. Old Republic argued that, because the topical cream was not recognized by the Food and Drug Administration […]
454-16-5262-m4-np
DECISION AND ORDER The Insurance Company of the State of Pennsylvania (Carrier) challenges the Medical Fee Dispute Findings and Decision of the Texas Department of Insurance, Division of Worker’s Compensation (Division or DWC), that ordered Carrier to pay an additional $1,572.45 to Physicians Surgical Center (Provider) for implantables used by Provider during surgery performed on […]
454-16-3686-m4-np
DECISION AND ORDER Hanger Prosthetics and Orthotics (Hanger) challenges a decision of the Texas Department of Insurance, Division of Worker’s Compensation (Division) that denied Hanger’s claim for reimbursement for prostheses and prosthetic services. Old Republic Insurance Company (Old Republic) argues that Hanger failed to timely file its request for Medical Fee Dispute Resolution and failed […]
454-15-3738-m4-np
DECISION AND ORDER Texas Mutual Insurance Company (TMIC) challenges a decision of the Texas Department of Insurance, Division of Workers’ Compensation (Division) holding that TMIC is liable for a medical bill from J. Thomas Dilger, Jr., M.D., associated with the treatment of an injured worker. On April 22, 2016, TMIC filed a Motion for Summary […]
454-16-2156-m4-np
DECISION AND ORDER ______ (Carrier) challenges a decision of the Texas Department of Insurance, Division of Worker’s Compensation that awarded Healthtrust full reimbursement for a chronic pain management program. In support of its assertion that Healthtrust is not entitled to $2,012.50 of the amount billed, ___ (carrier) argues that the program’s afternoon sessions were not […]
454-16-1884-m4-np
DECISION AND ORDER Traveler’s Indemnity Company of Connecticut (Traveler’s) challenges a decision of the Texas Department of Insurance, Division of Worker’s Compensation (Division) that awarded American Specialty Pharmacy (American) reimbursement for a combination of several drugs compounded into a topical cream. Traveler’s appeared at the hearing and presented evidence in support of its position that, […]
454-16-1182-m4-np
DECISION AND ORDER The State Office of Risk Management (Carrier or SORM) sought a contested case hearing regarding a Medical Fee Dispute Decision (MFD Decision) issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division). The MFD Decision ordered Carrier to reimburse Monzer Yazji, M.D. (Provider) the additional sum of $600.00, plus interest, […]
454-16-0182-m4-np
DECISION AND ORDER ________ (Petitioner) seeks reimbursement from Transportation Insurance Co. (Carrier) for medical costs he allegedly incurred after being injured at work. Petitioner appeals the decision that Carrier is not required to reimburse him $18,838.17 because, among other things, the request for Medical Fee Dispute Resolution (MFDR) was untimely filed. The Administrative Law Judge […]
454-15-4237-m4-np
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) sought a contested case hearing regarding a Medical Fee Dispute Decision (MFD Decision) issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division). The MFD Decision ordered Carrier to reimburse Salman Khan, D.C. (Provider) the additional sum of $150.00 for an impairment rating (IR) evaluation […]