The Texas Supreme Court ruled in favor of physicians in the case Patients Medical Center v. Facility Insurance Corporation, which questioned whether physicians had to assume the burden of proof throughout any medical fee dispute case that goes to SOAH, regardless of if the provider prevailed at the administrative level with the Division of Workers’ Compensation (TDI-DWC).
The Texas Supreme Court’s January 29, 2021, decision ruled in favor of the Workers’ Comp providers:
“We hold that in a worker’s compensation medical fee dispute resolution proceeding, the burden of proof in a contested case hearing before SOAH is on the party seeking review of the Division’s initial MFDR decision. Accordingly, the court of appeals erred in holding that the burden always and necessarily remains on the provider. The parties invite us to consider other briefed issues that the court of appeals did not reach, but we decline to do so. We reverse the court of appeals’ judgment and remand the case to that court to consider Facility’s unaddressed issues.”
The Texas Orthopaedic Association submitted an amicus brief.
Click here to view the Court’s January 29, 2021, ruling.
Click here to view TOA’s amicus brief.