453-03-2428-m2
DECISION AND ORDER This is an appeal from a decision by an Independent Review Organization (IRO) affirming Pacific Employers Insurance Company’s (Carrier) denial of preauthorization for a discogram with post CT scan as not medically necessary. The decision affirms the IRO because the Petitioner failed to appear at hearing, and the evidence supports the finding […]
453-05-9150-m2
DECISION AND ORDER I. INTRODUCTION American Home Assurance Company (Carrier) disputes a decision of an independent review organization (IRO) on behalf of the former Texas Workers’ Compensation Commission (TWCC)[1] regarding medical services for __ (Claimant). The IRO found that a four channel sequential interferential and muscle stimulator (RS-4i), to be provided by RS Medical (Provider), […]
453-06-0038-m2
DECISION AND ORDER __ (Claimant) challenged the decision of Continental Casualty Company (Carrier) denying preauthorization for a stellate ganglion block–right side. In this decision, the Administrative Law Judge (ALJ) finds that Claimant did not meet her burden of showing that the requested procedure is reasonable and necessary medical care and should be preauthorized. Therefore, the […]
453-04-3681-m2
DECISION AND ORDER I. DISCUSSION On February 11, 2004, RS Medical (Petitioner) requested a hearing before the State Office of Administrative Hearings (SOAH) following a February 3, 2004 Decision of the Texas Workers’ Compensation Commission (Commission) acting through the Texas Medical Foundation, an Independent Review Organization (IRO), denying the preauthorization request of Petitioner for the […]
453-05-9127-m2
DECISION AND ORDER The issue involved is whether Liberty Mutual Fire Insurance Company (Carrier) correctly denied preauthorization for eight botox injections for Claimant ___ (Claimant). Carrier denied the botox injections as not medically necessary. The Independent Review Organization (IRO) also found that the botox injections were not medically necessary. The Administrative Law Judge (ALJ) finds […]
453-05-9437-m2
DECISION AND ORDER ___ Petitioner and Claimant, sought a hearing before the State Office of Administrative Hearings (SOAH) following an Independent Review Organization (IRO) decision. The IRO recommended denial of pre-authorization for an S2 nerve block to relieve ___low back pain.The IRO concluded that the nerve block was not medically necessary because there was no […]
453-05-8606-m2
DECISION AND ORDER R.S. Medical (Provider) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) designee, an independent review organization (IRO), which upheld the denial by the State Office of Risk Management (SORM) of preauthorization of the purchase of a medical device called the RS-4i for use by a workers’ compensation claimant (Claimant). The […]
453-05-8864-m2
DECISION AND ORDER American Home Assurance Company (Carrier) challenged a decision by an Independent Review Organization (IRO) granting preauthorization of a lumbar myelogram with CT scan for claimant, ___(Claimant). The IRO found that the requested procedures were medically necessary. This decision finds that, based on the evidence presented during the hearing, the requested procedures should […]
453-05-9248-m2
DECISION AND ORDER South Texas Orthopaedic and Spinal Surgeon Associates, P.A., (Provider) challenges the decision of the Texas Workers’ Compensation Commission’s (Commission’s)[1] designee, an Independent Review Organization (IRO), upholding Hartford Underwriters Insurance Company’s (Carrier’s) denial of preauthorization of a lumbar discogram for Claimant___. This decision finds that the requested procedure should be preauthorized. I. NOTICE […]
453-05-9246-m2
DECISION AND ORDER Amcomp Assurance Corporation (Amcomp) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission’s) designee, an independent review organization (IRO), which granted pre-authorization for chronic pain management for claimant__. This decision concludes that pre-authorization should be denied. I.PROCEDURAL HISTORY, NOTICE, AND JURISDICTION Administrative Law Judge (ALJ) Shannon Kilgore convened the hearing on […]