Patients Medical Center v. Facility Insurance Corp. (Opinion)
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The Supreme Court reversed the judgment of the court of appeals remanding this medical fee dispute between a health care provider and a worker's compensation insurance carrier over the proper amount of reimbursement for services rendered to a covered patient, holding that that administrative law judge (ALJ) who heard the case properly applied the rules of the Texas Department of Insurance, Division of Workers' Compensation in allocating the burden of proof.
The provider initiated a dispute resolution proceeding, and the Division determined that the provider was entitled to more than the carrier believed was due. The Division ordered the carrier to pay the additional amount. The State Office of Administrative Hearings (SOAH) upheld the Division's determination. The court of appeals reversed, holding that the ALJ erred in placing the burden of proof on the carrier at the SOAH hearing and that the error prejudiced the carrier's substantial rights. The Supreme Court reversed, holding that the ALJ properly applied the Division's rules in concluding that the carrier had failed to meet its burden of proof.
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