453-05-5537-m4
DECISION AND ORDER The issue involved is whether Lawndale Medical Clinic (Provider) is entitled to reimbursement for certain chronic pain management services provided from December 17, 2002, to January 13, 2003. American Casualty Company of Reading, PA (Carrier) denied payment of Provider’s claims. The Administrative Law Judge (ALJ) finds that Provider failed to establish it […]
453-05-6616-m4
DECISION AND ORDER I. DISCUSSION The City of Rosenberg (Rosenberg) appeals a determination by the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission)[1] requiring Rosenberg to reimburse MHHS Hermann Hospital (Hermann) $101,874.40 for the 2003 hospitalization of claimant _____. Rosenberg argues that, following ______ emergency trauma admission, Hermann failed to seek necessary […]
453-05-2773-m4
DECISION AND ORDER Commerce & Industry Insurance Company (CIIC) is challenging the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission)[1] that the North Texas Pain Center (Pain Center) is due reimbursement for chronic pain management (CPM) provided to Claimant__. This decision concludes that CIIC should pay for the CPM […]
453-05-7486-m4
DECISION AND ORDER I. INTRODUCTION Pedro Nosnik, M.D., challenged a decision of the Texas Workers’ Compensation Commission’s (Commission’s)[1] Medical Review Division (MRD) that denied payment of $46 in reimbursement for a telephone conversation conducted December 20, 2004. This decision upholds MRD’s determination. The hearing convened on April 10, 2006, and the record closed that day. […]
453-04-5394-m4
DECISION AND ORDER In a decision dated March 23, 2004, the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission[1] (Commission) denied the request for additional reimbursement filed by Vista Medical Center Hospital (Vista) for services it provided to a workers’ compensation claimant during an inpatient hospital admission. MRD first determined that Texas Mutual […]
453-05-4246-m4
DECISION AND ORDER I. INTRODUCTION American Home Assurance Company appealed a Texas Workers’ Compensation Commission (Commission)[1] Medical Review Division’s (MRD’s) decision that ordered payment of $9,800 in reimbursement for 19 sessions of a chronic pain management (CPM) program provided from June 26, to July 30, 2003. This decision upholds MRD’s determination. The hearing convened as […]
453-05-1451-m4
DECISION AND ORDER Metropolitan Transit Authority Harris County (Carrier) appealed the findings and decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division (MRD),[1] which awarded additional reimbursement to RS Medical (Provider) for the use and purchase of an RS4i neuromuscular stimulator. The instrument was rented on June 27 and July 27, 2003, and […]
453-05-6393-m4
DECISION AND ORDER I. DISCUSSION This case concerns the proper level of reimbursement for the rental of an RS-4i neuromuscular stimulator, a piece of durable medical equipment (DME). Medical necessity is not an issue in this docket. The Administrative Law Judge (ALJ) concludes reimbursement should be at the amounts billed by RS Medical. The captioned […]
453-05-4323-m4
DECISION AND ORDER I. DISCUSSION In Docket No. 453-05-4323.M4 Texas Mutual Insurance Company (TMIC) requested a hearing to contest the January 28, 2005 Findings and Decision of the Texas Workers’Compensation Commission (Commission). In this fee dispute, the Commission ordered reimbursement to Texas Back Institute (TBI) for services provided to injured worker ___(Claimant__) on June 3, […]
453-05-4790-m4
DECISION AND ORDER I. Introduction National Union Fire Insurance Company (Carrier) disputes the decision of the Texas Workers= Compensation Commission (Commission)/Medical Review Division (MRD) ordering Carrier to pay additional reimbursement for medical services provided to Claimant by Interim HealthCare Services (Provider) between January 31 and March 26, 2004. The disputed amount is $13,938.77. Carrier requested […]