453-03-4456-m2
DECISION AND ORDER RS Medical (Petitioner) requested a hearing before the State Office of Administrative Hearings (SOAH) following a decision of the Texas Workers’ Compensation Commission (Commission) acting through Texas Medical Foundation, an Independent Review Organization (IRO), denying the preauthorization request of Petitioner for the purchase of an interferential and muscle stimulator for indefinite use […]
453-04-4638-m2
DECISION AND ORDER ___, the Claimant, sought preauthorization for a discogram with CT scan at discs C3 through T1.[1] Texas Mutual Insurance Company (Carrier) denied the request for preauthorization, and an Independent Review Organization (IRO) determined the requested treatment was not medically necessary. In this decision, the Administrative Law Judge (ALJ) agrees with the IRO […]
453-03-4359-m2
DECISION AND ORDER RS Medical (Petitioner) requested a hearing before the State Office of Administrative Hearings (SOAH) following a Decision of the Texas Workers’ Compensation Commission (Commission) acting through Texas Medical Foundation, an Independent Review Organization (IRO), denying the preauthorization request of Petitioner for the purchase of an interferential and muscle stimulator for indefinite use […]
453-04-5335-m2
DECISION AND ORDER American Home Assurance Company (Carrier) appeals the decision of an Independent Review Organization (IRO) granting preauthorization for a chronic pain management program to a worker’s compensation Claimant. This decision finds that the Carrier failed to sustain its burden of proving that the program is not medically necessary and preauthorizes the treatment. I. […]
453-04-6494-m2
DECISION AND ORDER Johann Van Beest, D.C., (Provider) challenged the decision of American Home Assurance Co. (Carrier), denying preauthorization for a lumbar discogram with CT scan (discogram). The dispute was referred to an Independent Review Organization (IRO), which authorized the procedure. In this decision, the Administrative Law Judge (ALJ) finds that Carrier proved by a […]
453-04-5730-m2
DECISION AND ORDER Petitioner ___, the workers’ compensation claimant (the Claimant), seeks preauthorization for a repeat MRI. The Administrative Law Judge (ALJ) denies the request. I. HISTORY AND ISSUES The Claimant, who was employed as a stocker at ___, injured her back ___. She began treatment with Richard Taylor, D.C., that month, and continued treatment […]
453-04-5976-m2
DECISION AND ORDER Kenneth Berliner, M.D. (Provider) sought preauthorization for a lumbar discogram with CT scan for injured worker ___ (Claimant). American Home Insurance Company (Carrier) determined that the procedure was unnecessary and denied the request for preauthorization. An Independent Review Organization (IRO) determined the requested treatment was medically necessary. In this decision, the Administrative […]
453-04-1157-m2
DECISION AND ORDER I. DISCUSSION ____ requested a hearing to contest an Independent Review Organization (IRO) decision that a chronic pain management program (CPMP or program) requested by Linh D. Vo, D.C., be preauthorized for an injured worker (Claimant).[1][2] ___ argued that the CPMP was medically unnecessary because it was unlikely to benefit the Claimant […]
453-04-6351-m2
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) requested a hearing on the decision of the Independent Review Organization (IRO)[1] approving the preauthorization request of Advantage Healthcare Systems (Provider) for two weeks of chronic pain management for injured worker ___ (Claimant). After considering the evidence and arguments presented, the Administrative Law Judge (ALJ) concludes that […]
453-04-5705-m2
DECISION AND ORDER I. DISCUSSION RS Medical (Petitioner) appealed the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Medical Review of Texas, an Independent Review Organization (IRO), denying the preauthorization request of Petitioner for the purchase of an RS-4i, a sequential stimulator that provides muscle and interferential current stimulation, for indefinite […]