453-03-2759-m2
DECISION AND ORDER American Home Assurance Company (Petitioner) is appealing the decision of Ziroc, an independent review organization (IRO) certified by the Texas Department of Insurance, in Texas Workers’ Compensation Commission (Commission) Medical Review Division tracking number M2-03-0778-01 granting preauthorization for a 30-session chronic pain management program. The IRO determined from the medical documentation submitted […]
453-03-3114-m2
DECISION AND ORDER _____ (Claimant) appealed the findings of the Texas Workers= Compensation Commission’s Medical Review Division (MRD), which denied Claimant’s request for preauthorization of a caudal catheter series because it found it was not reasonable or necessary health care under Tex. Lab. Code Ann. ‘ 408.021. This decision finds that the Claimant has met […]
453-03-2171-m2
DECISION AND ORDER I. DISCUSSION _____ (Petitioner) appealed the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Independent Review Incorporated, an Independent Review Organization (IRO). The Commission’s Order denied the preauthorization request of Petitioner for an open right carpal tunnel release. The Commission determined that an open right carpal tunnel release […]
453-03-2757-m2
DECISION AND ORDER Avner R. Griver, M.D. (Petitioner) appeals the decision of Independent Review, Inc., an independent review organization (IRO), denying preauthorization for a requested discogram. The IRO determined, based on the medical documentation submitted for review, that the requested procedure was not medically necessary to treat the Claimant’s condition. The Administrative Law Judge (ALJ) […]
453-03-2975-m2
DECISION AND ORDER I. DISCUSSION American Home Assurance Company (Petitioner) appealed the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Maximus, an Independent Review Organization (IRO)granting the preauthorization request of _____ (Patient) for a chronic pain management program. The Commission determined that the chronic pain management program was medically necessary within […]
453-03-2919-m2
DECISION AND ORDER ________ (the Claimant) challenges the decision of an Independent Review Organization (IRO) denying her request to preauthorize total knee replacement surgery. American Home Assurance Company (the Carrier) had denied the claim as medically unnecessary and the IRO upheld that decision. This decision finds that the requested procedure should not be preauthorized. I. […]
453-03-2430-m2
DECISION AND ORDER American Home Assurance Company (Carrier) appealed the decision of the Independent Review Organization (IRO) issued on February 19, 2002. The IRO ordered preauthorization for the reasonable and necessary costs of a lumbar myelogram for_______ (Claimant). In this decision, the Administrative Law Judge (ALJ) finds that Carrier met its burden of showing that […]
453-03-2756-m2
DECISION AND ORDER I. DISCUSSION America Home Assurance Company (Petitioner) appealed the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Envoy Medical Systems, LLC, an Independent Review Organization (IRO). The Commission’s Order granted the preauthorization request of _____ (Respondent) for a repeat Magnetic Resonance Imaging (MRI) of the cervical spine and […]
453-03-2012-m2
DECISION AND ORDER Positive Pain Management (Petitioner) appealed the decision of an Independent Review Organization (IRO) upholding the denial by the City of Conroe (Carrier) of preauthorization for a 20-day chronic pain management program (CPM). This decision reverses the IRO, because almost three years since her accident, the injured worker (Claimant) is still incapacitated by […]
453-03-1526-m2
DECISION AND ORDER John A. Sazy, M.D. (Provider), challenged the decision of American Casualty Company (Carrier) denying preauthorization for epidural steroid injections (ESI) and facet injections. In this decision, the Administrative Law Judge (ALJ) finds that the requested procedures should not be preauthorized. The hearing convened and closed on May 21, 2003, before Steven M. […]