453-03-4602-m2
DECISION AND ORDER I. DISCUSSION RS Medical (Petitioner) appealed the Findings and 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 indefinite use by ___ (Claimant).[1] This decision denies the […]
453-03-4604-m2
DECISION AND ORDER I. DISCUSSION RS Medical (Petitioner) appealed the Findings and 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 of an interferential and muscle stimulator for indefinite use by R.M. (Claimant).[1] This decision grants […]
453-04-0037-m2
DECISION AND ORDER I. DISCUSSION American Home Assurance Company (Petitioner) appealed the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through MAXIMUS, an Independent Review Organization (IRO), preauthorizing the use of an interferential and muscle stimulator for a trial period by I.P. (Claimant).[1] This decision denies the relief sought by Petitioner. A […]
453-04-0817-m2
DECISION AND ORDER I. DISCUSSION RS Medical (Petitioner) appealed the Findings and 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 indefinite use by D.F. (Claimant).[1] This decision grants the […]
453-03-4452-m2
DECISION AND ORDER American Home Assurance Company (AHAC or Carrier) appealed the decision by an Independent Review Organization (IRO) to grant preauthorization for Positive Pain Management (Provider) to provide chronic pain management services. AHAC disputes the IRO’s conclusion that these services are medically necessary. This decision agrees with the IRO and finds that the chronic […]
453-04-1511-m2
DECISION AND ORDER American Home Assurance Company (Petitioner) appealed the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Ziroc, an Independent Review Organization (IRO), approving the preauthorization request of Advantage Healthcare Systems (Respondent) for a chronic pain management program for J.H., Claimant.[1] After considering the evidence and arguments of the parties, […]
453-04-1804-m2
DECISION AND ORDER O.G., (Claimant) seeks an order from the State Office of Administrative Hearings (SOAH) to reverse the decision of the City of McAllen denying preauthorization for a custom knee brace for Claimant.[1] The Texas Workers= Compensation Commission (TWCC) Medical Review Division referred the dispute to an Independent Review Organization (IRO) for an Independent […]
453-04-1274-m2
DECISION AND ORDER ___ (Claimant), challenged the decision of Old Republic Insurance Company (Carrier) denying preauthorization for a lumbar discogram with CT Scan. The Texas Workers’ Compensation Commission (the Commission) Medical Review Division (MRD) dismissed Claimant’s request for reconsideration because it was untimely filed. In this decision, the Administrative Law Judge (ALJ) finds that Claimant […]
453-03-4454-m2
DECISION AND ORDER I. INTRODUCTION ___ (Claimant) has appealed a decision of the Texas Workers= Compensation Commission (TWCC) Medical Review Division (MRD) based on an independent review organization (IRO) review. The IRO agreed with the City of San Antonio (Carrier) that the Claimant did not reasonably medically need a left knee arthroscopy and meniscectomy to […]
453-03-2973-m2
DECISION AND ORDER I. DISCUSSION ___ (Petitioner) appealed the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through the Texas Medical Foundation, an Independent Review Organization (IRO), denying the preauthorization request of Petitioner for trigger point injections. The Commission determined that the trigger point injections were not medically necessary within the meaning […]