453-04-2217-m2
PROPOSAL FOR DECISION Ihsan Shanti, M.D. (Petitioner) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) designee, an independent review organization (IRO), in MDR Docket No. M2-04-0343-01, which upheld Liberty Mutual Insurance Corporation’s (Respondent) denial of preauthorization for epidural steroid injections for a workers’ compensation claimant (Claimant). Respondent denied the sessions as not being […]
453-04-4332-m2
DECISION AND ORDER The subject of this decision and order is a motion to dismiss brought by Respondent TASB Risk Management Fund Company (the Carrier). In its motion, the Carrier contends that this case should be dismissed from the docket of the State Office of Administrative Hearings (SOAH) because Petitioner failed to timely file a […]
453-04-1641-m2
DECISION AND ORDER Travelers Indemnity Company (Carrier) challenges the decision of an Independent Review Organization (IRO) granting the request of ___ (Claimant) for a home whirlpool hot tub. Carrier had denied the claim as medically unnecessary; however, the IRO disagreed, finding that the use of the whirlpool hot tub is clinically indicated for Claimant’s medical […]
453-04-1158-m2
DECISION AND ORDER Texas Mutual Insurance Company (Petitioner) requested a hearing before the State Office of Administrative Hearings following a Decision of the Texas Workers’ Compensation Commission (Commission) acting through Independent Review Incorporated, an Independent Review Organization (IRO). The Commission’s Order granted a preauthorization request for work conditioning for _______ (Claimant). This decision grants the […]
453-04-1199-m2
DECISION AND ORDER Injured worker _____ (Petitioner) challenges the denial of preauthorization by Zurich American Insurance Company (Respondent) for a surgical transposition of Petitioner’s right ulnar nerve at the elbow. Respondent denied the procedure as not medically necessary. The Administrative Law Judge (ALJ) concludes that while surgical intervention might one day prove medically necessary, more […]
453-04-1159-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 Medical Review of Texas, an Independent Review Organization (IRO), denying the preauthorization request of Petitioner for the purchase an interferential and muscle stimulator for […]
453-04-2216-m2
DECISION AND ORDER ___ (Petitioner) requested a hearing before the State Office of Administrative Hearings following a Decision of the Texas Workers’ Compensation Commission (Commission) acting through MAXIMUS, an Independent Review Organization (IRO). The Commission’s Order denied Petitioner’s preauthorization request for a lumbar myelogram with CT scan. The Commission determined that the lumbar myelogram with […]
453-04-1510-m2
DECISION AND ORDER After an Independent Review Organization (IRO) granted preauthorization for a chronic pain management program, TPCIGA for Colonial Casualty Insurance 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 […]
453-04-1156-m2
DECISION AND ORDER ________, Petitioner, seeks preauthorization for purchase of an RS4i sequential 4-channel combination interferential and muscle stimulator (RS4i stimulator). The Administrative Law Judge (ALJ) concludes the purchase of the RS4i stimulator should not be preauthorized. I. DISCUSSION Petitioner injured his neck and shoulder ________, while hauling coal for his employer. He received several […]
453-04-1539-m2
DECISION AND ORDER I. INTRODUCTION Insurance Company of North America (Carrier) appealed an independent review organization’s (IRO) determination that it should pre-authorize Howard J. Hassell, M..D. (Provider) to perform a discogram on Claimant. Carrier denied the pre-authorization, contending the discogram was not medically necessary to treat Claimant’s compensable injury. The IRO found that it was […]