453-04-3584-m2
DECISION AND ORDER American Home Assurance Company (Carrier) appeals an Independent Review Organization (IRO) decision to grant preauthorization for a chronic pain management program for an injured employee who sustained an injury to her lower back. This decision finds that the Carrier failed to sustain its burden of proving that the program is not medically […]
453-04-2218-m2
DECISION AND ORDER The issue in this case is whether an MRI of the Claimant’s cervical spine should be preauthorized. The Administrative Law Judge (ALJ) finds that the MRI should not be preauthorized. I. DISCUSSION In August of 2003, the Claimant’s treating doctor, Douglas Farnsworth, D.C., requested preauthorization for an MRI of the Claimant’s cervical […]
453-03-4353-m2
DECISION AND ORDER ___ (Claimant) disputes the decision of an Independent Review Organization (IRO) designated by the Medical Review Division (MRD) of the Texas Workers= Compensation Commission (the Commission, TWCC) affirming the denial by American Home Assurance Company (Carrier) of pre-authorization for a cervical myelogram and a CT scan. The Administrative Law Judge (ALJ) finds […]
453-04-3585-m2
DECISION AND ORDER Maximum Therapeutic Initiative (MTI or the Petitioner) seeks preauthorization to conduct a work hardening program for ___, a workers’ compensation claimant (the Claimant). The Administrative Law Judge (ALJ) concludes a six-week program of work hardening should be preauthorized and so orders. I. FACTUAL AND PROCEDURAL HISTORY The Claimant injured her shoulder ___, […]
453-04-1200-m2
DECISION AND ORDER ___. (the Claimant”) challenges the decision of an Independent Review Organization (IRO) denying his request to preauthorize total knee replacement surgery. Continental Casualty Company (the Carrier) denied the claim as medically unnecessary and the IRO upheld that decision. This decision finds that the requested procedure should be preauthorized. I. JURISDICTION, NOTICE, AND […]
453-04-1317-m2
DECISION AND ORDER RS Medical requested a hearing to contest an Independent Review Organization (IRO) decision denying preauthorization of a RS 4i Sequential Stimulator (RS 4i Stimulator) for indefinite use by an injured worker (Claimant). The Administrative Law Judge (ALJ) concludes the RS 4i Stimulator was not shown to be medically necessary. A hearing convened […]
453-04-3629-m2
DECISION AND ORDER I. INTRODUCTION American Home Assurance Company (Carrier) disputes a decision of an independent review organization (IRO) on behalf of the Texas Workers= Compensation Commission (TWCC) regarding a medical service for ___ (Claimant). Advantage Healthcare Systems (Provider) sought pre-authorization from the Carrier for the Claimant to participate in 30 sessions of a chronic-pain-management […]
453-04-1176-m2
DECISION AND ORDER RS Medical requested a hearing to contest an Independent Review Organization (IRO) decision denying preauthorization of a RS 4i Sequential Stimulator (RS 4i Stimulator) for indefinite use by an injured worker (Claimant). The Administrative Law Judge (ALJ) concludes the RS 4i Stimulator was shown to be medically necessary. A hearing convened on […]
453-04-1177-m2
DECISION AND ORDER I. DISCUSSION 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 Independent Review Incorporated, an Independent Review Organization (IRO), denying the preauthorization request of Petitioner for the purchase of an interferential and muscle stimulator for […]
453-04-4453-m2
DECISION AND ORDER ___ (Petitioner) challenges a decision of an Independent Review Organization (IRO) denying requested preauthorization for bilateral transforminal epidural steroid injections (ESIs) with fluoroscopy. Preauthorization of the treatment was not shown to be medically necessary. I. DISCUSSION A. Background Petitioner is a ___ year-old female who sustained a work related injury on ___, […]