453-03-1908-m2
DECISION AND ORDER American Home Assurance Company (the Carrier) challenges the decision of an Independent Review Organization (IRO) requiring the Carrier to pay for a single Bretylium Bier Block injection to provide pain relief to the Claimant’s right arm.[1] The Carrier argued that the injection is medically unnecessary. Based on the Respondent’s deemed admission that […]
453-03-1099-m2
DECISION AND ORDER _________ (“Petitioner”) appeals an Independent Review Organization (“IRO”) decision in a preauthorization dispute. The IRO found that a lumbar discogram was not medically necessary to treat the injured worker. This decision agrees with Carrier, and finds the discogram is not medically necessary or reasonable. I. Notice, Jurisdiction, and Procedural History Notice and […]
453-03-2170-m2
DECISION AND ORDER __________ (Petitioner) appealed the Independent Review Organization’s (IRO=s) decision denying her preauthorization for a lumbosacral spine discogram (discogram). This decision finds the requested preauthorization should be granted. I. JURISDICTION, NOTICE, AND PROCEDURAL HISTORY There were no contested issues of jurisdiction or notice. Therefore, those matters are addressed in the findings of fact […]
453-03-0691-m2
DECISION AND ORDER Texas Evaluation and Management Specialist (TEMS) is appealing the decision of the Texas Workers’ Compensation Commission’s (Commission=s) designee, an independent review organization (IRO), which denied preauthorization for 30 sessions of chronic pain management for Claimant P.D. This decision concludes that preauthorization should not be granted. I.PROCEDURAL HISTORY, NOTICE, AND JURISDICTION Administrative Law […]
453-03-1754-m2
DECISION AND ORDER This is a dispute over preauthorization for facet injections. The Administrative Law Judge (ALJ) concludes the injections should be preauthorized. I. Discussion The Claimant suffered a compensable back injury on_________. She underwent a spinal fusion, with placement of BAK cages, in July of 1999 at the L4/L5 level. She continued to suffer […]
453-03-1316-m2
DECISION AND ORDER John A. Sazy, M.D., appealed an Independent Review Organization (IRO) decision denying preauthorization of a magnetic resonance imaging (MRI) and CT discogram for an injured worker’s lumbar spine on the basis that they were not medically necessary. This decision concludes that the MRI and CT discogram are medically necessary and should be […]
453-03-1710-m2
DECISION AND ORDER American Home Assurance Company (Petitioner) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) designee, an Independent Review Organization (IRO), which granted preauthorization to Kenneth Berliner, M.D., (Respondent) for a right ulnar nerve transposition but denied preauthorization for a right carpal tunnel release procedure for a workers’ compensation claimant (Claimant). This […]
453-03-1756-m2
DECISION AND ORDER I. Introduction American Home Assurance Company (Carrier) has appealed a decision of an independent review organization (IRO) regarding preauthorization of medical services for____ (Claimant). The IRO found it is medically necessary for the Claimant to have surgery to release her right ulnar nerve. The only disputed issue is whether adequate documentation was […]
453-03-0688-m2
DECISION AND ORDER _______. (Claimant), an injured worker, challenges the decision of an Independent Review Organization (IRO) upholding the decision of Transportation Insurance Company (Carrier) to deny her request for a Chronic Pain Management (CPM) program. This decision finds that the evidence supports the medical necessity of a CPM program. Administrative Law Judge (ALJ) Gary […]
453-03-0689-m2
DECISION AND ORDER The Neuromuscular Institute of Texas, P.A. (Institute) is appealing the decision of the Texas Workers’ Compensation Commission’s (Commission’s) designee, an independent review organization (IRO), which denied preauthorization for 20 sessions of chronic pain management for Claimant ___. This decision concludes that preauthorization should not be granted. I.PROCEDURAL HISTORY, NOTICE, AND JURISDICTION Administrative […]