453-02-3866-m2
DECISION AND ORDER I. Introduction Insurance Company of The State of Pennsylvania (Carrier) has appealed a decision of an independent review organization (IRO) in a Texas Workers’ Compensation Commission (TWCC) pre-authorization dispute. The IRO determined that a magnetic resonance imaging (MRI)[1] prescribed by Danny R. Bartel, M.D. (Provider) was medically necessary and should be preauthorized […]
453-02-3067-m2
DECISION AND ORDER ____ (Claimant) has appealed a decision of the Independent Review Organization (IRO). The IRO agreed with the determination made by American Interstate Insurance Co. (Carrier) which denied preauthorization for an IDET[1] procedure on Claimant. In this decision, the Administrative Law Judge (ALJ) finds that Claimant has not met its burden of showing […]
453-02-3486-m2
DECISION AND ORDER I. Summary Dr. Sanjoy Sundaresan, M.D. (Petitioner), sought review of an decision by a reviewer with an independent review organization (IRO) who concluded that a discography examination by Petitioner of ___’s (Claimant) spine was not medically necessary at this point in Claimant’s treatment. Liberty Mutual Insurance Group (Carrier) had declined to preauthorize […]
453-02-3288-m2
DECISION AND ORDER _________ has appealed a decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission). MRD ordered preauthorization for the reasonable and necessary costs for a motorized wheelchair for____ (Respondent/Claimant), suffering from Reflex Sympathetic Dystrophy (RSD).[1] In this decision, the Administrative Law Judge (ALJ) finds that _________ has failed […]
453-02-3636-m2
DECISION AND ORDER I. Summary Petitioner ________ seeks preauthorization for outpatient methadone drug rehabilitation treatment associated with pain medication addiction, relating to a compensable injury that occurred on ___. The decision issued by the Texas Medical Foundation’s independent review organization (IRO), pursuant to the Texas Workers’ Compensation Commission (TWCC) rules, found that outpatient methadone drug […]
453-02-3487-m2
DECISION AND ORDER (Petitioner) is appealing the decision of the Texas Medical Foundation, an independent review organization (IRO) certified by the Texas Department of Insurance, in Texas Workers’ Compensation Commission (Commission) Medical Review Division tracking number M2-02-0490-01 denying preauthorization for a surgical exploration of the abdominal wall with mesh placement. The IRO determined from the […]
453-02-3523-m2
DECISION AND ORDER The claimant in this case has a compensable back injury. The carrier, AMCOMP Assurance Corporation (AAC), denied pre-authorization for a chronic pain management program for the claimant. At issue is whether a chronic pain management program is reasonable and necessary to treat this claimant’s compensable injury. The Administrative Law Judge (ALJ) concludes […]
453-02-2300-m2
DECISION AND ORDER American Home Assurance Company (Petitioner) appealed the findings and decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division (MRD) in MDR Docket No. M2-01-0990-01, which granted preauthorization of a thoracic discogram with CT scan by Dr. Charles R. Gordon, M.D. (Provider) for a worker’s compensation claimant (Claimant). This decision finds […]
453-02-2384-m2
DECISION AND ORDER St. Paul Fire & Marine Insurance Company (Petitioner or Carrier) appealed the findings of the Texas Workers’ Compensation Commission’s Medical Review Division (MRD) which approved Positive Pain Management’s (Provider’s) request for preauthorization for twenty sessions of chronic pain management. This decision disagrees with the MRD and finds the requested twenty sessions of […]
453-02-2296-m2
DECISION AND ORDER Continental Casualty Company (Carrier) has appealed a decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission). MRD ordered preauthorization for a lumbar discogram to be performed on ___, an injured worker. In this decision, the Administrative Law Judge (ALJ) finds that Carrier has met its burden of […]