453-03-4225-m2
DECISION AND ORDER John A. Sazy, M.D. (Provider), challenged the decision of Insurance Company of the State of Pennsylvania (Carrier) denying preauthorization for an EMG (electromyography) and NCS (nerve conduction studies) for ________ (Claimant). In this decision, the Administrative Law Judge (ALJ) finds that Provider met its burden of showing that the requested procedures are […]
453-04-0620-m2
DECISION AND ORDER The State Office of Risk Management[1] (SORM) denied preauthorization for arthroscopic knee surgery to reconstruct ______(Petitioner’s) left anterior cruciate ligament (ACL) and to perform medial and lateral meniscectomies. The independent review organization (IRO) agreed that the proposed surgery was not medically necessary. ____appealed the IRO’s decision. The Administrative Law Judge (ALJ) determines […]
453-03-4358-m2
DECISION AND ORDER RS Medical (RS) appealed an Independent Review Organization (IRO) determination that the purchase of a RS-4i Sequential Stimulator (Stimulator) is medically unnecessary and should not be authorized to treat a lower back injury suffered by an injured worker (Claimant). Argonaut Midwest Insurance Company (Argonaut) had previously denied RS’s request for the purchase. […]
453-04-0148-m2
DECISION AND ORDER Behavioral Healthcare Associates (Petitioner) appealed the decision of the Texas Workers= Compensation Commission’s (Commission) designee, an independent review organization (IRO), which denied preauthorization for a chronic pain management (CPM) program for a workers= compensation claimant (Claimant). Petitioner’s request for the CPM had been denied by the American Home Assurance Company (Respondent) as […]
453-03-4223-m2
DECISION AND ORDER This dispute arose as a result of a request for work hardening services provided by Eric Vanderwerff, D.C. (Provider), to____ (Claimant), a maintenance laborer who sustained injuries to his wrist from a work-related injury on ___________. Provider seeks preauthorization for the services. The ALJ finds that the Provider’s services cannot be preauthorized […]
453-04-0610-m2
DECISION AND ORDER American Home Assurance Company (Carrier) is appealing the decision of the Texas Workers’ Compensation Commission’s (Commission’s) designee, an independent review organization (IRO), which found that a right carpal tunnel release and right ulnar nerve transposition are medically necessary for the treatment of Claimant ____. This decision finds that the treatments are not […]
453-04-0815-m2
ORDER NO. 1 GRANTING CONTINUANCE On November 4, 2003, Pacific Employers Insurance Company (Carrier) filed a motion for continuance. Carrier states that its testifying witnesses are unavailable for the hearing currently scheduled for Wednesday, November 5, 2003, at 11:00 a.m. Because Carrier’s witnesses are unavailable for hearing on November 5, 2003, the Administrative Law Judge […]
453-03-3880-m2
DECISION AND ORDER American Home Assurance Co. (Carrier) appealed an Independent Review Organization (IRO) decision granting preauthorization of a lumbar CT discogram for an injured worker’s lumbar spine on the basis that it was not medically necessary. This decision concludes that the CT discogram is medically necessary and should be authorized. I. JURISDICTION AND HEARING […]
453-03-3993-m2
DECISION AND ORDER ______ (Petitioner) appealed a decision by an independent review organization (IRO), which denied preauthorization for Petitioner to obtain a second Magnetic Resonance Image (MRI) of his lumbo-sacral spine. The IRO concluded that a second MRI was not medically necessary because there had been no change in Petitioner’s orthopedic or neurologic objective findings […]
453-03-3763-m2
DECISION AND ORDER ____ (Claimant), challenged the decision of Travelers Indemnity Company of Texas (Carrier) denying preauthorization for a lumbar discogram. In this decision, the Administrative Law Judge (ALJ) finds that Claimant did not meet her burden of showing that the requested procedures are medically necessary and should be preauthorized. Therefore, the ALJ does not […]