Texas Mutual Insurance Co. v. Stelzer

Texas Mutual Insurance Co. v. Stelzer

Dr. Stelzer, D.C. sought reimbursement for a needle EMG.  Texas Mutual argued a chiropractor could not receive reimbursement for a needle EMG.  The dispute was decided by an administrative law judge at the State Office of the Administrative Hearings (SOAH).  SOAH determined that Dr. Stelzer should be reimbursed.  This finding was contingent on the Texas Board of Chiropractic Examiners (TBCE) determining that needle EMGs are within the scope of practice of chiropractors and at all times relevant to this dispute.
 
Texas Mutual appealed the decision to district court.  However, TMI did not challenge the scope of practice issue by requesting a declaratory judgment and therefore waived its right to dispute that issue.
 
The court of appeals held the Division of Worker’s Compensation’s own guidelines applied the Texas Board of Chiropractic Examiners scope of practice interpretations.  Because the Texas Board of Chiropractic Examiners allowed needle EMGs at all times relevant in the dispute, Dr. Stelzer is entitled to reimbursement for this procedure.  [Lexis.com subscribers may read the full enhanced version of Tex. Mut. Ins. Co. v. Stelzer, 2010 Tex. App. LEXIS 236 (Tex. App. Austin Jan. 13, 2010)].