453-03-0186-m2
DECISION AND ORDER __ (Petitioner) appealed a decision by the Texas Medical Foundation, an independent review organization (IRO), which denied preauthorization for Petitioner to obtain a third Magnetic Resonance Image (MRI) of her lumbosacral spine. The IRO concluded that a third MRI was not medically necessary because there had been no change in Petitioner’s orthopedic […]
453-03-0701-m2
DECISION AND ORDER I. Summary This case is an appeal by Texas Mutual Insurance Company (Petitioner) from the decision issued by the Texas Medical Foundation’s independent review organization (IRO), pursuant to the Texas Workers= Compensation Commission (Commission) rules. The IRO had determined that the requested procedure, lumbar discogram with post CT scan, was medically necessary, […]
453-03-0080-m2
DECISION AND ORDER Neuromuscular Institute of Texas, P.A., (Provider) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) designee, an independent review organization (IRO), in MDR Docket No. M2-02-0803-01, which upheld San Antonio I.S.D.’s (Respondent) denial of preauthorization of biofeedback sessions for a workers’ compensation claimant (Claimant). Respondent denied the sessions as not being […]
453-03-0076-m2
DECISION AND ORDER Positive Pain Management (Petitioner) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) designee, an independent review organization (IRO), which denied preauthorization for a chronic pain management (CPM) program for a workers’ compensation claimant (Claimant).[1] Petitioner’s request for the CPM had been denied by the American Home Assurance Company (Respondent) as […]
453-03-0343-m2
DECISION AND ORDER American Home Assurance Company (Carrier) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) designee, an independent review organization (IRO), which granted Dr. Nathan Breazeale’s (Provider) preauthorization request for shoulder surgery for a workers’ compensation claimant (Claimant).[1] Carrier denied preauthorization on the basis the surgery was not medically necessary healthcare. This […]
453-02-3601-m2
DECISION AND ORDER _____ (Claimant) has appealed a decision of the independent review organization (IRO), the designee of the Texas Workers’ Compensation Commission (Commission), denying preauthorization for attendant care for Claimant. In this decision, the Administrative Law Judge (ALJ) finds that Claimant has failed to meet his burden of showing that the requested treatment is […]
453-02-3787-m2
DECISION AND ORDER Insurance Company of the State of Pennsylvania (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 M2-02-0770-01 granting preauthorization for the requested revision fusion procedure[1] and cardiac stress […]
453-02-3616-m2
DECISION AND ORDER __________ (Petitioner) has appealed the findings of Independent Review, Inc. (IRI) affirming the denial by East Texas Educational Insurance Association (Carrier) of pre-authorization for three lumbar sympathetic blocks to be administered to Petitioner over three consecutive weeks. The Administrative Law Judge (ALJ) holds that pre-authorization should be ordered for the requested treatment, […]
453-03-4227-m2
DECISION AND ORDER John A. Sazy, M.D. (Provider), challenged the decision of Lumberman’s Mutual Casualty Company (Carrier) denying preauthorization for a lumbar discogram for (Claimant). In this decision, the Administrative Law Judge (ALJ) finds that Provider met his burden of showing that the requested procedure is reasonable and necessary medical care and should have been […]
453-02-3524-m2
DECISION AND ORDER Positive Pain Management (Petitioner) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) designee, an independent review organization (IRO), in MDR Docket No. M2-02-0598-01 which denied preauthorization for a chronic pain management (CPM) program for a workers’ compensation claimant (Claimant). Petitioner’s request for the CPM had been denied by the Spring […]