453-03-1240-m2
DECISION AND ORDER This case involves the appeal by the American Home Assurance Company (Carrier), from the decision of an Independent Review Organization (IRO) that approved a request for preauthorization for an outpatient lateral epicondylectomy and lateral release on the right side.[1] The decision agrees with the IRO that the procedures are medically necessary and […]
453-03-0988-m2
DECISION AND ORDER The issue in this case is whether EMG guided Botox injections should be preauthorized to treat the compensable work injury of ______ (Claimant). The Administrative Law Judge (ALJ) disagrees with the decision of the Independent Review Organization (IRO) and issues this decision and order preauthorizing the injections. I. Discussion On _________, the […]
453-03-1242-m2
DECISION AND ORDER I. Summary Texas Intergovernmental Risk Pool (Carrier) sought review of the preauthorization by an independent review organization (IRO) of six months of in-home nursing and health aide care for _____________(Claimant). Carrier had denied Claimant’s request for the service on the basis that more appropriate care would be rendered in a skilled nursing […]
453-03-1016-m2
DECISION AND ORDER I. Introduction American Casualty Company of Reading, PA. (Carrier) has appealed a decision of an independent review organization (IRO) recommending preauthorization of a medical service for ___. (Claimant). The only disputed issue is whether the service for which preauthorization is soughtBneurolysis and anterior intramuscular transposition of the Claimant’s right ulnar nerve (Requested […]
453-03-1017-m2
ORDER GRANTING DISMISSAL FOR LACK OF SUBJECT MATTER JURISDICTION The above styled cause was called to hearing on February 6, 2003, at the hearing facilities of the State Office of Administrative Hearings (SOAH) in Austin, Texas. Petitioner appeared by telephone assisted by Ombudsman Juan Mireles who appeared in person. Respondent appeared in person by attorney […]
453-03-0983-m2
DECISION AND ORDER John A. Sazy, M.D. (Petitioner) is appealing the decision of Envoy Medical Systems, LLC, an independent review organization (IRO) certified by the Texas Department of Insurance, in Texas Workers’ Compensation Commission (Commission) Medical Review Division tracking number M2-02-1148-01denying preauthorization for the requested two level fusion (TLIF) at the L4-L5 and L5-S1 levels. […]
453-03-1584-m2
DECISION AND ORDER American Home Assurance Company (Carrier) appealed the Independent Review Organization’s (IRO=s) decision to preauthorize neurocognitive rehabilitation and psychotherapy for D. H. (Claimant). 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 […]
453-03-1241-m2
DECISION AND ORDER This case is a request for preauthorization for surgery to repair a left rotator cuff tear. The Administrative Law Judge (ALJ) concludes the surgery should be preauthorized. I. Discussion ________, the Petitioner, sustained compensable injuries______, from lifting a cooler. The Petitioner was employed by________. On September 29, 2001, he underwent surgery to […]
453-03-1100-m2
DECISION AND ORDER American Home Assurance Company (AHAC or the Carrier), the Petitioner in this case, seeks reversal of an Independent Review Organization (IRO) decision. The IRO decision preauthorized individual psychotherapy and biofeedback for a workers’ compensation claimant, as requested by the Respondent, Behavioral Healthcare Associates (BHA). The Administrative Law Judge (ALJ) concludes the IRO […]
453-03-1482-m2
DECISION AND ORDER I. Introduction American Home Assurance Company (Carrier) disputes a decision of an independent review organization (IRO) regarding the request by George J. Murillo, M.D. (Treating Physician) for preauthorization of a repeat psychiatric interview (repeat interview) of ____ (Claimant). The IRO found that the Claimant reasonably needed a repeat interview to treat her […]