453-03-2693-m2
DECISION AND ORDER John A. Sazy, M.D. (Provider), challenged the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission) denying preauthorization for a pre-surgery MRI test for ______ (Claimant) in connection with his cervical spine injury. The review was conducted by an independent review organization (IRO). The MRD concluded that […]
453-04-1189-m2
DECISION AND ORDER I. DISCUSSION RS Medical 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 denied. This decision authorizes the purchase of the RS 4i Stimulator. A hearing convened on April […]
453-04-4476-m2
DECISION AND ORDER I. Introduction Texas Mutual Insurance Co. (Carrier) has appealed a decision of an independent review organization (IRO), on behalf of the Texas Workers= Compensation Commission (TWCC), regarding medical services for G.R. (Claimant). The Carrier was asked by Shanti Pain Management Clinic, P.A. (Provider) to pre-authorize the Claimant’s participation in 30 sessions in […]
453-03-4640-m2
DECISION AND ORDER Positive Pain Management (Provider) appealed the decision of an Independent Review Organization (IRO) upholding the denial of preauthorization for a chronic pain management (CPM) program for an injured worker (Claimant). The Administrative Law Judge (ALJ) finds that Provider did not meet its burden of showing that the requested CPM program was reasonable […]
453-04-3630-m2
DECISION AND ORDER The City of Galveston (Petitioner) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) designee, an independent review organization (IRO), in MR Docket No. M2-04-0630-01, which granted a request by psychologist Steven Callahan, Ph.D., (Respondent) for preauthorization of a chronic pain management (CPM) program for a workers’ compensation claimant (Claimant). Petitioner’s […]
453-04-1018-m2
DECISION AND ORDER I. DISCUSSION RS Medical 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 denied. This decision concludes the RS 4i Stimulator was not shown to be medically necessary. A […]
453-04-1951-m2
DECISION AND ORDER Ihsan F. Shanti, M.D. (Provider) disputes the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (the Commission, TWCC) affirming the denial by Lumbermen’s Mutual Casualty Company (Carrier) of pre-authorization for cervical transforaminal epidural steroid injections to treat Claimant’s compensable injury. The Administrative Law Judge (ALJ) finds that […]
453-04-3505-m2
DECISION AND ORDER After an Independent Review Organization (IRO) granted preauthorization for a chronic pain management program, The Travelers Indemnity Company (Carrier) appealed. 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. PROCEDURAL HISTORY, NOTICE, AND JURISDICTION There are […]
453-04-3679-m2
DECISION AND ORDER The issue involved is whether Pacific Employers Insurance Company (Carrier) correctly denied preauthorization for eight botox injections with EMG guidance for Claimant ___ (Claimant). Carrier denied the botox injections as not medically necessary. The Independent Review Organization (IRO) also found that the botox injections were not medically necessary. The Administrative Law Judge […]
453-04-2777-m2
DECISION AND ORDER An injured worker (Claimant) appealed an independent review organization (IRO) determination that a work hardening program she requested was medically unnecessary. Her insurance carrier, Louisiana Pacific Corporation (Louisiana Pacific), had denied the claim. This decision concludes that the Claimant did not prove the need for a work hardening program because the evidence […]