453-04-5852-m2
DECISION AND ORDER American Home Assurance Company (Carrier) challenges the decision of an Independent Review Organization (IRO) approving preauthorization of a lumbar discogram for workers= compensation Claimant ________. The Carrier denied the requested procedure on the basis that it was not medically necessary. The IRO reversed that decision. This decision finds that the requested procedure […]
453-04-6495-m2
DECISION AND ORDER This case is an appeal by American Home Assurance Company (APetitioner), from a decision of an independent review organization (AIRO) on behalf of the Texas Workers= Compensation Commission (ACommission) in a dispute regarding preauthorization for epidural steroid injections sought by Workers= Healthcare (ARespondent). The IRO found that Petitioner incorrectly denied preauthorization of […]
453-04-3678-m2
DECISION AND ORDER The issue in this case is whether a lumbar discogram with CT scan of the Claimant’s spine should be preauthorized. The Administrative Law Judge (ALJ) finds that the discogram should be preauthorized. I. DISCUSSION In September of 2003, the Claimant’s doctor, Dr. Wayne Paullus, M.D., a neurosurgeon, (requesting physician) requested preauthorization for […]
453-04-5230-m2
DECISION AND ORDER ___ (Climant) challenges the decision of an Independent Review Organization (IRO) denying her request to preauthorize surgery for a AdeQuervain’s release to relieve symptoms related to carpal tunnel syndrome on her right hand. The Claimant’s employer, Fort Worth Independent School District (the Carrier) is self insured under the workers= compensation system and […]
453-04-4585-m2
DECISION AND ORDER ___ appealed an Independent Review Organization (IRO) decision that denied preauthorization for Claimant to receive an intra-discal electro thermal annuloplasty (IDET) at disk levels L4-5 and L5-S1. The IRO concluded that the procedure was not medically necessary and was contraindicated based on ___’s symptoms. This decision agrees with the IRO and concludes […]
453-04-5792-m2
DECISION AND ORDER ___ (Petitioner) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division (MRD) in Docket No. M2-04-1235-01, which dismissed her request for preauthorization of the purchase of a TENS unit based on Petitioner’s failure to request reconsideration of the initial denial by V.F. Corporation (Respondent), a self-insurer under the […]
453-04-0150-m2
DECISION AND ORDER ___, the Petitioner in this case, seeks preauthorization for a repeat tenolysis of the extensor tendon of his right middle finger, with tissue interposition between the tendon and the proximal phalanx. The Administrative Law Judge (ALJ) concludes the procedure should be preauthorized. I. FACTUAL AND PROCEDURAL HISTORY The Petitioner, who was a […]
453-04-4333-m2
DECISION AND ORDER Claimant___, requested a hearing to contest an Independent Review Organization (IRO) decision to deny preauthorization for a chronic pain management program. Claimant is an injured employee who sustained a work-related injury to her knee and lower back. The Administrative Law Judge (ALJ) finds that authorization should be ordered for the requested treatment […]
453-04-5363-m2
DECISION AND ORDER American Home Assurance Company (Petitioner) appealed the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through the Texas Medical Foundation, an Independent Review Organization (IRO), approving the preauthorization request of Behavioral Healthcare Associates (Respondent) for psychological testing and biofeedback.[1] Following a hearing and consideration of the evidence, the Administrative […]
453-04-3609-m2
DECISION AND ORDER Kenneth G. Berliner, M.D., (Petitioner) appealed the Independent Review Organization’s (IRO=s) decision denying preauthorization for a left shoulder arthroscopic labral repair. This decision finds the requested preauthorization should be granted. I. JURISDICTION, NOTICE, AND PROCEDURAL HISTORY There were no contested issues of jurisdiction or notice. Therefore, those matters are addressed in the […]