453-04-4637-m2
DECISION AND ORDER Advantage Healthcare Systems (Petitioner) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) designee, an independent review organization (IRO), which denied preauthorization for a chronic pain management (CPM) program for a workers’ compensation claimant (Claimant). The Petitioner’s request for the CPM had been denied by Dallas County Hospital District (Carrier) as […]
453-04-1589-m2
DECISION AND ORDER Positive Pain Management (Provider) requested a hearing to contest a decision by Medical Review of Texas, an independent review organization (IRO), affirming the denial by Zurich American Insurance Company (Carrier) of pre-authorization for an additional 20 sessions[1]of chronic pain management for ___ (Claimant). The Administrative Law Judge (ALJ) holds that pre-authorization should […]
453-04-0007-m2
DECISION AND ORDER I. INTRODUCTION ___ (Claimant) has appealed a decision of an independent review organization (IRO) on behalf of the Texas Workers= Compensation Commission (TWCC). The decision concerned the Bituminous Casualty Corporation’s (Carrier=s) denial of P.E. Garcia=s, M.D., (Provider=s) request for pre-authorization of medical services for the Claimant. The IRO found that the request […]
453-04-2313-m2
DECISION AND ORDER I. INTRODUCTION John A. Sazy, M.D., (Provider) has appealed a decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission (TWCC). The decision concerned the Texas Association of School Boards Risk Management Fund’s (Carrier’s) denial of the Provider’s request for pre-authorization of medical services for ___ (Claimant). […]
453-04-0784-m2
DECISION AND ORDER Work Ready Rehab Centers (Provider)[1] appealed the findings and decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission). The Commission referred the dispute to an Independent Review Organization (IRO) which found that the last two weeks of Provider’s work hardening program provided to an injured worker (Claimant) […]
453-04-2297-m2
DECISION AND ORDER ___ (Claimant) challenges the decision of an Independent Review Organization (IRO) denying his request to preauthorize the purchase of an orthopaedic bed. The National Fire Insurance Company of Hartford (Carrier) had denied the claim as medically unnecessary and the IRO upheld that decision. This decision finds that the requested purchase should not […]
453-04-2469-m2
DECISION AND ORDER ___ (Claimant) challenges the decision of an Independent Review Organization (IRO) denying preauthorization of a lumbar discogram. University of Texas System (the Carrier) had denied the requested procedure on the basis that it was not medically necessary and the IRO upheld that decision. This decision finds that the requested procedure should be […]
453-04-4583-m2
DECISION AND ORDER First Rio Valley Medical, P.A., (Provider) requested a hearing to contest a decision by Envoy Medical Systems, L.P., an independent review organization (IRO), affirming the denial by American Home Assurance Company (Carrier) of pre-authorization for eight weeks of work hardening for A.G. (Claimant). The Administrative Law Judge (ALJ) holds that pre-authorization should […]
453-04-2775-m2
DECISION AND ORDER I. Introduction American Manufactures Mutual Insurance Company (Carrier) has appealed a decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission (TWCC). Tarrant County Chiropractic & Rehabilitation, Inc. (Treating Physician) requested pre-authorization of certain medical services for A.M. (Claimant). The IRO found those services-right knee arthroscopy/meniscectomy, chondroplasty, […]
453-04-4291-m2
DECISION AND ORDER Valley Comprehensive Pain Management Center (Valley) appealed an independent review organization (IRO) determination that a chronic pain management program (Program) it requested was medically unnecessary to treat an injured worker (Claimant). TML Intergovernmental Risk Pool (TML) was the insurance carrier. The Administrative Law Judge (ALJ) concludes that the Program was medically necessary […]