453-03-3992-m2
DECISION AND ORDER Neuromuscular Institute of Texas (Petitioner) appealed an Independent Review Organization (IRO) decision denying preauthorization for Claimant to receive a repeat electromyogram/nerve conduction velocity test (EMG/NCV) of the left upper extremity. The IRO concluded that this test was not medically necessary. This decision agrees with the IRO and concludes that the test is […]
453-03-3788-m2
DECISION AND ORDER John A. Sazy, M.D. (Petitioner) is appealing the decision of Independent Review Incorporated, an independent review organization (IRO) certified by the Texas Department of Insurance, in Texas Workers’ Compensation Commission (Commission or TWCC) Medical Review Division tracking number M2-03-0933-01, denying preauthorization for the requested discogram of the lumbar spine with post discogram […]
453-03-3868-m2
DECISION AND ORDER Southwestern Pain Institute, P.A. (Provider), challenged the decision of Hartford Underwriters Insurance Company (Carrier) denying preauthorization for a trial spinal cord stimulator for Claimant. In this decision, the Administrative Law Judge (ALJ) finds that the requested procedure should be preauthorized. The hearing convened and closed on August 11, 2003, before Steven M. […]
453-03-3363-m2
DECISION AND ORDER Claimant ____ appealed the decision of an Independent Review Organization (IRO) denying preauthorization for the reasonable and necessary costs of a lumbar paravertebral nerve block. In this decision, the Administrative Law Judge (ALJ) finds that Claimant did not meet its burden of showing the requested procedure was medically necessary. Therefore, American Home […]
453-03-3420-m2
DECISION AND ORDER Petitioner, American Home Assurance Company (Petitioner, the Carrier), appealed a decision of an independent review organization (IRO) designated by the Texas Workers= Compensation Commission (Commission), in which an IRO doctor determined diagnostic lumbar facet injections should be preauthorized for Claimant_______ (Claimant). Respondent, Arun Lall, M.D.(Respondent, Dr. Lall) administered the injections after receiving […]
453-03-4027-m2
DECISION AND ORDER American Home Assurance Company (AHAC or Carrier) appealed the decision by an Independent Review Organization (IRO) to grant preauthorization for Claimant___ to receive 30 sessions of chronic pain management services. AHAC disputes the IRO’s conclusion that these services are medically necessary. This decision agrees with AHAC and finds that the chronic pain […]
453-03-3419-m2
DECISION AND ORDER I. Summary American Home Assurance Company (Carrier) sought review of a decision by the Medical Review Division (MRD) of the Texas Workers= Compensation Commission (TWCC or Commission) declining to preauthorize lumbar spinal injections to treat ____’s (Claimant) back injury. The substantive review of Carrier’s claim was conducted by an Independent Review Organization […]
453-03-2846-m2
DECISION AND ORDER I. Summary John A. Sazy, M.D. (Petitioner), sought review of a decision by the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC or Commission) declining to preauthorize a lumbar discogram with CT scan to diagnose the nature of the back injury suffered by____ (Claimant). The substantive review of Petitioner’s […]
453-03-3618-m2
DECISION AND ORDER American Home Assurance Company (AHAC or Carrier) appealed the decision by an Independent Review Organization (IRO) to grant preauthorization for Claimant ____ to receive 30 sessions of 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 […]
453-03-3619-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 psychological evaluation and medications are medically necessary for the treatment of Claimant____. This decision finds that the medications were medically necessary and that Claimant is entitled […]