453-03-3592-m2
DECISION AND ORDER I. DISCUSSION A. Background ___ (Claimant), an injured worker, challenges the decision of an Independent Review Organization affirming the denial of preauthorization for carpal ligament decompression and reconstruction. The Administrative Law Judge (ALJ) concludes the medical necessity of the procedure was not established by the evidence. A hearing convened August 28, 2003, […]
453-03-3637-m2
DECISION AND ORDER This issue in this case is whether a chronic pain management program should have been preauthorized for the Claimant. The Administrative Law Judge concludes it should. I. Factual and Procedural History The Claimant in this case sustained a compensable back injury on_________, while working at________. Conservative treatment was tried, but she continued […]
453-03-3806-m2
DECISION AND ORDER I. DISCUSSION RS Medical (Petitioner) appealed the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through ZRC Services, Inc., d/b/a Ziroc, an Independent Review Organization (IRO),[1] denying the preauthorization request of Petitioner for the purchase an interferential and muscle stimulator for indefinite use by I.M. (Patient).[2] This decision denies […]
453-03-3703-m2
DECISION AND ORDER I. DISCUSSION Neuromuscular Institute of Texas (Petitioner) appealed the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Forte, an Independent Review Organization (IRO) denying the preauthorization request of Petitioner for ten individual psychotherapy sessions for D.D. (Patient).[1] This decision denies the relief sought by Petitioner for ten additional […]
453-03-1901-m2
DECISION AND ORDER This case involves a request for authorization to perform a lumbar discogram with CT scan. An Independent Review Organization (IRO) reviewed this case for the Texas Workers= Compensation Commission (TWCC or Commission) and found that the requested procedure was medically necessary. This decision reverses the decision of the IRO and finds that […]
453-03-2754-m2
DECISION AND ORDER _______ (Claimant) and his treating physician, J.A.S., M.D. (Dr. J.A.S.) (collectively, Petitioners)[1] have appealed an Independent Review Organization’s (IRO’s) conclusion that American Company of Reading (Carrier) was correct in denying preauthorization for an IDET procedure[2] because IDET therapy is not medically necessary for this Claimant. The Administrative Law Judge finds that Petitioners […]
453-03-2377-m2
DECISION AND ORDER John A. Sazy, M.D. appealed an Independent Review Organization (IRO) decision denying preauthorization for Claimant ____ (Claimant) to undergo electromyography/nerve conduction velocity studies (EMG/NCV)[1] of the bilateral lower extremities. The IRO concluded that the EMG/NCV was not medically necessary. This decision agrees with the IRO and concludes that the EMG/NCV is not […]
453-03-3994-m2
DECISION AND ORDER This case is an appeal by American Home Assurance Company (Petitioner) from a decision by an Independent Review Organization (IRO) in a preauthorization dispute initiated before the Texas Workers= Compensation Commission (Commission). The IRO ordered approval of preauthorization for neuroplasty decompression medial/radial nerve and internal neurolysis nerve graft. Petitioner challenged the IRO’s […]
453-03-4228-m2
DECISION AND ORDER This case is an appeal by the Neuromuscular Institute of Texas, PA (APetitioner), from a decision of an independent review organization (AIRO) on behalf of the Texas Workers= Compensation Commission (ACommission) in a dispute regarding requested preauthorization for psychotherapy sessions. The IRO found that the Via Metropolitan Transit (ARespondent)Bacting as a self-insurerBproperly […]
453-03-3188-m2
DECISION AND ORDER The Insurance Company of the State of PA (Carrier) appealed the decision by an Independent Review Organization (IRO) to grant preauthorization for Claimant to purchase a BMR NT 2000 Neuromuscular Stimulator. The cost of the unit is $2,195.00, plus $85.00 per month for supplies. Carrier disputes the IRO’s conclusion that these services […]