Texas Workers’ Compensation

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19016
November 7, 2019

DECISION AND ORDER

This case is decided pursuant to Chapter 410 of the Texas Workers’ Compensation Act and the Rules of the Texas Department of Insurance, Division of Workers’ Compensation. In accordance with the parties’ agreement, the Administrative Law Judge determines that Claimant is entitled to deep hardware removal and removal of support implant for the (Date of Injury), compensable injury.

STATEMENT OF THE CASE

On November 7, 2019, Kara Squier, a Division administrative law judge, held a contested case hearing to decide the following disputed issue:

Is Claimant entitled to deep hardware removal and removal of support implant for the (Date of Injury), compensable injury?

PARTIES PRESENT

Claimant/Petitioner appeared and was assisted by DC, ombudsman. Insurance Carrier/Respondent appeared and was represented by WS, attorney.

AGREEMENT

The parties reached an agreement. The agreement resolves only those issues to be decided at this hearing. The agreement does not resolve all issues with regard to this claim and is not a settlement.

In this decision, this Agreement section includes findings of fact and the Decision section constitutes the conclusions of law.

The Administrative Law Judge found the following fact:

Insurance Carrier delivered to Claimant a single document stating the true corporate name of Insurance Carrier, and the name and street address of Insurance Carrier’s registered agent, which document was admitted into evidence as Administrative Law Judge’s Exhibit Number 2.

The parties agreed as follows:

  1. 1.Venue is proper in the (City) Field Office of the Texas Department of Insurance, Division of Workers’ Compensation.
  2. 2.On (Date of Injury), Claimant was the employee of (Employer), Employer.
  3. 3.On (Date of Injury), Employer provided workers’ compensation insurance through Indemnity Insurance Company of North America, Insurance Carrier.
  4. 4.On (Date of Injury), Claimant sustained a compensable injury.
  5. 5.Claimant is entitled to deep hardware removal and removal of support implant for the (Date of Injury), compensable injury.

DECISION

Claimant is entitled to deep hardware removal and removal of support implant for the (Date of Injury), compensable injury.

ORDER

Insurance Carrier/Respondent is ordered to pay benefits in accordance with this decision, the Texas Workers’ Compensation Act, and the Commissioner’s Rules. Accrued but unpaid income benefits, if any, shall be paid in a lump sum together with interest as provided by law.

The true corporate name of the Insurance Carrier/Respondent is INDEMNITY INSURANCE COMPANY OF NORTH AMERICA, and the name and address of its registered agent for service of process is

CT CORPORATION SYSTEM

1999 BRYAN STREET, SUITE 900

DALLAS, TX 75201-3136

Signed this 7th day of November, 2019.

Kara Squier

Administrative Law Judge

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At a Glance:

Title:

19016

Decision Type:

MCCH Decision

Date:

November 7, 2019

MCCH Type:

Non-Network
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