453-03-0185-m2
DECISION AND ORDER Petitioner, ___ a workers’ compensation claimant, appealed the Independent Review Organization’s (AIRO’s) decision that denied his request for a discogram.[1] Hartford Underwriters Insurance Company (ACarrier) argued that the discogram was unnecessary. This decision finds in Petitioner’s favor and preauthorizes the discogram at levels L1-2 and L2-3. I. Notice, Jurisdiction, and Procedural History […]
453-03-0700-m2
DECISION AND ORDER Petitioner,____,[1] appealed an Independent Review Organization (IRO) reviewer’s decision denying preauthorization for an above-ground swimming pool. The IRO reviewer found and the Carrier argued that the pool was not a reasonable therapy option. This decision finds that the pool is not a medical aid or device and, further, is not reasonable and […]
453-03-1020-m2
DECISION AND ORDER _____________ (Petitioner) has appealed the findings of Independent Review, Inc. (IRI) affirming the denial by Travelers Indemnity Company of Connecticut (Carrier) of pre-authorization for a lumbar discogram[1] followed by a CT[2] scan. The Administrative Law Judge (ALJ) holds that pre-authorization should be ordered for the requested treatment because it is medically necessary […]
453-03-0837-m2
DECISION AND ORDER Jack Barnett, D.C. is appealing the decision of the Texas Workers’ Compensation Commission’s (Commission’s ) designee, an independent review organization (IRO), which denied preauthorization for 30 work hardening sessions for Claimant ____ Dr. Barnett’s request was previously denied by American Protection Insurance Company (the Carrier). This decision concludes that preauthorization should not […]
453-03-1178-m2
DECISION AND ORDER John A. Sazy, M.D. (Provider) has appealed the decision of an Independent Review Organization (IRO)[1] denying authorization for knee replacement surgery for ____ a workers= compensation claimant (Claimant). In this decision, the Administrative Law Judge (ALJ) finds that knee replacement surgery is reasonable and necessary medical care for Claimant. Therefore, ___ ___________(Carrier) […]
453-03-0986-m2
DECISION AND ORDER Transcontinental Insurance Company (the Carrier) requested a hearing to challenge a decision of the Texas Workers’ Compensation Commission’s (the Commission) independent review organization (IRO) granting preauthorization for a comprehensive pain management program for an injured worker (the Claimant). The Administrative Law Judge (ALJ) finds that the pain management program is not medically […]
453-03-0686-m2
DECISION AND ORDER I. INTRODUCTION Petitioner, the Texas Association of School Boards Risk Management Fund (Petitioner, the Carrier), appealed a decision of an independent review organization (IRO) designated by the Texas Workers= Compensation Commission (Commission), in which an IRO chiropractor recommended preauthorization for six weeks of work hardening for Claimant____. (Claimant). The Administrative Law Judge […]
453-03-0985-m2
DECISION AND ORDER John A. Sazy, M.D. (Petitioner) has appealed the findings of Independent Review, Inc. (IRI) affirming the denial by Travelers Indemnity Company of Connecticut (Carrier) of pre-authorization for three epidural steroid injections and facet injections to be administered to Petitioner’s patient _____(Claimant). The Administrative Law Judge (ALJ) holds that pre-authorization should be ordered […]
453-03-0690-m2
DECISION AND ORDER American Home Assurance Company (Carrier) appealed the decision of the Independent Review Organization (IRO) issued on September 12, 2002. The IRO ordered preauthorization for the reasonable and necessary costs of a lumbar discogram with CT scan for______ (Claimant). In this decision, the Administrative Law Judge (ALJ) finds that Carrier failed to meet […]
453-03-0835-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 M2-02-0922-01denying preauthorization for the requested discogram with CT scan. The IRO determined from the medical […]