453-03-4439-m2
DECISION AND ORDER I. INTRODUCTION ____ (Claimant) has appealed a decision of the Texas Workers= Compensation Commission (TWCC) Medical Review Division (MRD), which was based on an independent review organization (IRO) review. That decision denied preauthorization of a right carpal tunnel release (Proposed Release) for the Claimant. The IRO found that the Proposed Release was […]
453-03-4247-m2
DECISION AND ORDER I. Summary Kenneth G. Berliner, M.D., of Lone Star Orthopedics (Provider), sought review of a decision issued on July 1, 2003, by the Medical Review Division (MRD) of the Texas Workers= Compensation Commission (Commission) declining to preauthorize tarsal tunnel release to treat _____(Claimant) right ankle injury on the grounds it was not […]
453-03-4453-m2
DECISION AND ORDER I. INTRODUCTION _______ (Claimant) has appealed a decision of the Texas Workers= Compensation Commission (TWCC) Medical Review Division (MRD), which was based on an independent review organization (IRO) review. That decision denied preauthorization of a chronic-pain management program (Pain Program) for the Claimant. The IRO found that the Pain Program was not […]
453-03-4222-m2
DECISION AND ORDER American Home Assurance Company (Carrier) appealed the decision of the Independent Review Organization (IRO) approving the preauthorization request of Susan Linder, M.D. (Provider) for 15 additional sessions of chronic pain management for_____, an injured worker. After considering the evidence and arguments of the parties, the Administrative Law Judge (ALJ) concludes that Carrier […]
453-01-3076-m2
DECISION AND ORDER Texas Property and Casualty Insurance Guaranty Association (Petitioner) appealed a decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission), preauthorizing home health care for_____ (Respondent). After a review of the evidence, the Administrative Law Judge (ALJ) finds that home health care is not reasonable and necessary medical […]
453-03-4390-m2
DECISION AND ORDER Kenneth G. Berliner, M.D. (Petitioner) has appealed the findings of an independent review organization (IRO) affirming the denial by American Home Assurance Company (Carrier) of pre-authorization for right knee meniscal debridement[1] and chondroplasty[2] to be administered to Petitioner’s patient (Claimant). The Administrative Law Judge (ALJ) finds that pre-authorization should be ordered because […]
453-03-4028-m2
DECISION AND ORDER I. INTRODUCTION American Home Assurance Company (Carrier) has appealed an independent review organization (IRO) determination. Guy O. Danielson, III, M.D. (Provider) asked for pre-authorization to perform a left ulnar nerve decompression and left carpel tunnel release (Disputed Services) on____ (Claimant). The Carrier had denied the pre-authorization, contending the Disputed Services were not […]
453-03-4029-m2
DECISION AND ORDER American Home Assurance Company (American Home) appealed a Texas Workers Compensation Commission (Commission) Medical Review Division (MRD) decision preauthorizing discography for an injured worker (claimant)’s spine. American Home appeared at the hearing and produced credible evidence that the discography is not medically necessary. Although his office was contacted at the beginning of […]
453-03-4352-m2
DECISION AND ORDER The Texas A&M University System (A&M) denied preauthorization for a provocative lumbar discogram with fluoroscopy as medically unnecessary. An Independent Review Organization (IRO) concluded that A&M’s denial was correct. The injured worker____ (Claimant or Petitioner), has appealed the IRO’s decision. The Administrative Law Judge (ALJ) determines that the requested discogram is reasonable […]
453-03-3869-m2
DECISION AND ORDER _____ (Petitioner) is appealing the decision of Forte, an independent review organization (IRO) certified by the Texas Department of Insurance, in Texas Workers’ Compensation Commission (Commission) Medical Review Division tracking number M2-03-1013-01 denying preauthorization for a left cervical facet block with trigger point injections followed one week later by a right cervical […]