453-05-0616-m2
DECISION AND ORDER Texas Mutual Insurance Company (TMIC) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission’s) designee, an independent review organization (IRO), which granted preauthorization for chronic pain management for Claimant ___ This decision concludes that preauthorization should not be granted. I.PROCEDURAL HISTORY, NOTICE, AND JURISDICTION Administrative Law Judge (ALJ) Katherine L. Smith […]
453-04-7658-m2
DECISION AND ORDER I. DISCUSSION ___ (Claimant),[1] an injured worker, requested a hearing to contest an Independent Review Organization (IRO) decision that an epidural steroid injection (ESI) prescribed by his doctor should not be preauthorized because it is not medically necessary. The Administrative Law Judge (ALJ) agrees that, based upon the medical information presented at […]
453-05-0160-m2
DECISION AND ORDER This is a dispute over a request for preauthorization for botox injections to relieve back pain suffered by workers’ compensation claimant ___ (the Claimant). The Administrative Law Judge (ALJ) concludes the request should be denied. I. HISTORY The Claimant suffered a compensable injury to his back and leg on ___. He has […]
453-05-0073-m2
DECISION AND ORDER Injured worker ___ (Claimant) challenges the denial of preauthorization by Argonaut Insurance Company (Carrier) for eight botox injections to treat Petitioner’s compensable back injury. Respondent denied the procedure as not medically necessary. The Administrative Law Judge (ALJ) concludes that the proposed injections were medically necessary for the treatment of his injury. Consequently, […]
453-04-5855-m2
DECISION AND ORDER This is a dispute over a request for preauthorization for a cervical myelogram with CT for workers’ compensation claimant ____ (Claimant). The Administrative Law Judge (ALJ) concludes the request should be denied. I. HISTORY The Claimant, who was a supervisor at ____, was injured on ____, when a shelf hit her on […]
453-05-0537-m2
DECISION AND ORDER I. INTRODUCTION Valley Integrated Pain Assessment and Care (AProvider) challenged a decision by an Independent Review Organization (AIRO), issued on behalf of the Texas Workers’Compensation Commission (ACommission) in a preauthorization dispute. The IRO found that Crum & Forster Indemnity Company (ACarrier) properly denied preauthorization for a chronic pain management program (ACPMP), intended […]
453-05-0515-m2
DECISION AND ORDER I. DISCUSSION Action Care Rehabilitation Center (Petitioner) requested a hearing following the August 27, 2004 Independent Review Organization’s decision to deny preauthorization for 30 sessions of a chronic pain management program (requested services). The Administrative Law Judge (ALJ) concludes that Petitioner failed to timely request from the American Home Assurance Company (Respondent) […]
453-05-0057-m2
DECISION AND ORDER Facility Insurance Corporation (Carrier) appealed an Independent Review Organization (IRO) decision that recommended pre-authorization of bilateral facet injections for Claimant, as requested by his doctor Jacob Rosenstein, M.D. (Provider).The IRO concluded the injections were medically necessary. This decision disagrees with the IRO and concludes that the bilateral facet injections are not medically […]
453-04-8914-m2
DECISION AND ORDER I. INTRODUCTION American Home Assurance Co. (Carrier) disputes a decision of an independent review organization (IRO) on behalf of the Texas Workers= Compensation Commission (TWCC) regarding medical services for ___ (Claimant). The IRO agreed with Jeffery Wasserman, M.D. (Provider) and found that an intrathecal narcotic injection should be pre-authorized to treat the […]
453-04-5350-m2
DECISION AND ORDER American Home Assurance Company (Carrier) challenged the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission) authorizing Advantage Healthcare Systems (Provider) to administer a chronic pain management course to ___(Claimant). The MRD concluded that chronic pain management was medically necessary to treat Claimant. Based on the evidence, […]