453-05-7317-m2
DECISION AND ORDER The State Office of Risk Management (SORM) requested a hearing to contest an Independent Review Organization (IRO) determination that the purchase of an RS-4i Sequential Stimulator (RS-4i) is medically necessary and should be authorized for treating at-work injuries suffered by an injured worker (Claimant). This decision concludes that the RS-4i is medically […]
453-05-9249-m2
DECISION AND ORDER I. DISCUSSION ___ (Petitioner), sought a review of the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Forte, an Independent Review Organization (IRO). The Commission’s Order affirmed the decision of Service Lloyds Insurance Company (Respondent) to deny a request for a single upright knee orthosis (knee brace) with […]
453-05-7763-m2
DECISION AND ORDER Workers’ compensation claimant __(Claimant) challenges the decision of an Independent Review Organization[1] denying preauthorization for the purchase of an interferential muscle stimulator, model RS4i (RS4i), at a cost of $2,495. In this decision, the Administrative Law Judge (ALJ) finds that the Claimant did not establish that the requested equipment is medically necessary. […]
453-05-8826-m2
DECISION AND ORDER Petitioner, American Home Assurance Company, (Carrier) challenged the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC)[1] granting preauthorization for an injured worker (Claimant) to receive twenty sessions of a chronic pain management program at the request of Positive Pain Management (Provider). The Administrative Law […]
453-05-9071-m2
DECISION AND ORDER American Home Assurance Company (Carrier) challenged the decision of the Texas Workers’ Compensation Commission (the Commission) Medical Review Division (MRD) granting preauthorization for an epidural steroid injection with flouroscopy and epidurogram under intravenous (IV) sedation prescribed by David B. Graybill, D.O. (Provider). In this decision, the Administrative Law Judge (ALJ) finds that […]
453-05-8280-m2
DECISION AND ORDER Claimant filed this petition challenging the decision of an Independent Review Organization (IRO) denying preauthorization of a discogram. The IRO upheld the decision of Indemnity Insurance Company (Carrier) to deny the requested procedure on the basis that it was not medically necessary. Based on the evidence presented during the hearing, the Administrative […]
453-05-9110-m2
DECISION AND ORDER Zurich American Insurance Company (Carrier) challenges an order by an independent review organization (IRO) that four individual counseling sessions and eight sessions of biofeedback should be pre-authorized to treat the compensable low back injury of an injured worker, ___ (Claimant). The Administrative Law Judge (ALJ) concludes that the proposed treatment is not […]
453-05-7674-m2
DECISION AND ORDER __, a workers= compensation insurance claimant (Claimant), challenged the decision of an Independent Review Organization (IRO) denying preauthorization of four individual psychotherapy sessions and eight biofeedback sessions for chronic pain management. The IRO found that the requested procedures were not medically necessary. This decision finds that, based on the evidence presented during […]
453-05-7903-m2
DECISION AND ORDER I. INTRODUCTION Texas Mutual Insurance Company (Carrier) and Cotton Merritt, D.C.(Provider) each dispute a decision by an independent review organization (IRO), on behalf of the Texas Workers’ Compensation Commission (TWCC), regarding medical services for __(Claimant). One IRO agreed with the Carrier and found the services that the Claimant obtained from the Provider […]
453-05-9319-m2
DECISION AND ORDER Arvo Neidre, M.D. (Provider or Dr. Neidre) challenged the decision of an Independent Review Organization (IRO) denying preauthorization of a discogram for workers’ compensation insurance claimant, ___ (Claimant). The IRO found that the requested procedure was not medically necessary. This decision finds that, based on the evidence presented during the hearing, the […]