453-03-4641-m2
DECISION AND ORDER Petitioner, Orthofix, Inc., on behalf of a workers’ compensation claimant, appealed the Independent Review Organization’s (IRO) decision that denied Claimant’s request to purchase an Orthotrac Pneumatic Vest (Orthotrac).[1] American Casualty Company of Reading, PA (Carrier) argued that the vest is not medically necessary. This decision finds in Petitioner’s favor and preauthorizes the […]
453-04-0991-m2
DECISION AND ORDER John A. Sazy, M.D. (Provider), challenged the decision of United Pacific Insurance Company, an Impaired Company (Carrier), denying preauthorization for a lumbar discogram with CT Scan for ___ (Claimant). In this decision, the Administrative Law Judge (ALJ) finds that Provider did not meet its burden of showing that the requested procedure is […]
453-03-4229-m2
DECISION AND ORDER RS Medical (RS) appealed an independent review organization (IRO) determination that the purchase of an RS-4i Sequential Stimulator (Stimulator) is medically unnecessary to treat a lower-leg injury suffered by a ___(City) employee (Claimant). The City had previously denied RS’s request for the purchase. This decision concludes that RS failed to prove the […]
453-04-0612-m2
DECISION AND ORDER The subject of this decision and order is a motion to dismiss brought by the Zurich American Insurance Company (Carrier). In its motion, Carrier contended that this case should be dismissed from the docket of the State Office of Administrative Hearings (SOAH) because Petitioner, ___, filed a late appeal under the rules […]
453-03-4473-m2
DECISION AND ORDER An injured worker (Petitioner) appealed an Independent Review Organization (IRO) determination that a lumbar discogram and post discogram CT were not medically necessary to treat his lower back injury. Twin City Fire Insurance Company (Carrier) had previously denied the Petitioner’s request to authorize the procedures. This decision concludes, based on a preponderance […]
453-04-0240-m2
DECISION AND ORDER ___ (Petitioner) is appealing the decision of the Texas Workers’ Compensation Commission (Commission), which adopted the decision of an independent review organization (IRO) denying preauthorization for surgery, specifically, amputation of the left leg below the knee. The IRO determined from the medical documentation submitted for review that the requested medical procedure was […]
453-03-4129-m2
DECISION AND ORDER American Home Assurance Company (AHAC), appealed an Independent Review Organization (IRO) decision approving preauthorization for Claimant ________ to receive a lumbar diskogram at levels L3-4, L4-5, and L5-S1. The IRO concluded that these tests were medically necessary to determine the source of ________’s low back pain that has persisted for over two […]
453-03-4554-m2
DECISION AND ORDER Neuromuscular Institute of Texas, PA (Provider), challenged the decision of San Antonio ISD (Carrier) denying preauthorization for eight counseling sessions for _____ (Claimant). In this decision, the Administrative Law Judge (ALJ) finds that Provider met its burden of showing that the requested counseling sessions are reasonable and necessary medical care and should […]
453-03-4226-m2
DECISION AND ORDER John A. Sazy, M.D. (Petitioner), appealed an Independent Review Organization (IRO) decision denying preauthorization of a magnetic resonance imaging (MRI), three lumbar epidural steroid injections, and three facet injections. This decision concludes that requested services are medically necessary and should be preauthorized. I.JURISDICTION & HEARING Because there were no challenges to notice […]
453-03-4246-m2
DECISION AND ORDER ______ (Petitioner) appealed the Independent Review Organization’s (IRO=s) decision denying preauthorization for a right shoulder arthroscopy and acromioplasty. This decision finds the requested preauthorization should be granted. I. JURISDICTION, NOTICE, AND PROCEDURAL HISTORY There were no contested issues of jurisdiction or notice. Therefore, those matters are addressed in the findings of fact […]