453-04-8363-m2
DECISION AND ORDER American Home Assurance Company (Carrier) appealed the decision of the Independent Review Organization (IRO) approving the preauthorization request of North Texas Pain Recovery Center (Provider) for 10 days (80 hours) of chronic pain management for Claimant, an injured worker. After considering the evidence presented, the Administrative Law Judge (ALJ) concludes that Carrier […]
453-04-1319-m2
DECISION AND ORDER After an Independent Review Organization (IRO) granted preauthorization for eight weekly sessions of individual counseling, the University of Texas System (Carrier) appealed. This decision finds that the counseling sessions sought by Neuromuscular Institute of Texas (Provider) are medically necessary. Preauthorization is granted. I. JURISDICTION, NOTICE, AND PROCEDURAL HISTORY There were no contested […]
453-04-5364-m2
DECISION AND ORDER American Home Assurance Company (Carrier) seeks review of a decision by the Texas Workers’ Compensation Commission (Commission), acting through an independent review organization (IRO), in a dispute regarding preauthorization for a left knee arthroscopy with partial medial meniscectomy. The Commission granted preauthorization of the requested treatment for ___ (Claimant). In this decision, […]
453-04-7262-m2
DECISION AND ORDER South Coast Spine & Rehab Center, P.A. (Provider) is challenging the determination of the independent review organization (IRO) upholding the decision of TML Intergovernmental Risk Pool (Carrier) to deny as medically unnecessary thirty sessions of a work hardening program for ___ (Claimant). The Administrative Law Judge (ALJ) concludes that preauthorization for the […]
453-04-8229-m2
DECISION AND ORDER After an Independent Review Organization (IRO) denied preauthorization for a lumbar spinal MRI, Claimant appealed. This decision finds that Claimant’s physician has not documented his reasons for requesting a second lumbar spinal MRI and that Claimant did not prove that the MRI he seeks is medically necessary. Preauthorization is denied. I. JURISDICTION, […]
453-04-7261-m2
DECISION AND ORDER I. INTRODUCTION Kenneth Berliner, M.D. (Provider) disputes a determination by an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission (TWCC) regarding medical services for ___ (Claimant). The IRO found that the Claimant did not have reasonable medical need a total right knee arthroplasty (knee replacement). For that reason, […]
453-04-8264-m2
DECISION AND ORDER After an Independent Review Organization (IRO) denied preauthorization for a lumbar discogram, Claimant appealed. This decision finds that the lumbar discogram is medically necessary and orders preauthorization. I. JURISDICTION, NOTICE, AND PROCEDURAL HISTORY There were no contested issues of jurisdiction, notice, or venue. Therefore, those issues are addressed in the findings of […]
453-04-5114-m2
DECISION AND ORDER I. DISCUSSION Federal Insurance Company (FIC) requested a hearing to contest an independent review organization (IRO) determination that preauthorization of a RS 4i Sequential Stimulator (RS 4i Stimulator) for indefinite use by an injured worker (Claimant) should be approved. This decision concludes the RS 4i Stimulator is not medically necessary for the […]
453-04-6039-m2
DECISION AND ORDER I. DISCUSSION RS Medical requested a hearing to contest an independent review organization (IRO) determination denying preauthorization of an RS 4i Sequential Stimulator (RS 4i Stimulator) for indefinite use by an injured worker (Claimant). This decision concludes the RS 4i Stimulator is not medically necessary for the nature of Claimant’s injury. A […]
453-04-6044-m2
DECISION AND ORDER ABF Freight Systems (ABF), a self-insured employer, has appealed the decision by an Independent Review Organization (IRO) to grant preauthorization for Claimant ____ to receive renovations to his home to accommodate his handicap and to receive a handicap-accessible van. ABF disputes that these items are “health care” as defined by the Texas […]