453-02-2168-m2
DECISION AND ORDER ___(Petitioner) appealed the findings and decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division’s (MRD) docket number M2-02-0206-01. The MRD decision upheld the denial by Pennsylvania General Insurance Company (Carrier) of Petitioner’s request for preauthorization of ambulatory surgical center care for 25295,Tenolysis Forearm/Wrist, 64721, Neuroplsty TRNSP Median, 14040, TS TRNSFR […]
453-02-2383-m2
DECISION AND ORDER _______ (Claimant) appealed the findings of the Texas Workers’ Compensation Commission’s Medical Review Division (MRD), which denied Claimant’s request for preauthorization for intradiscal electro thermal therapy finding that it was not reasonable or necessary health care under Tex. Lab. Code Ann. §408.021. This decision finds that the Claimant has met his burden […]
453-02-3318-m2
DECISION AND ORDER Gabriel Gutierrez, D.C., appealed the Independent Review Organization’s (“IRO’s”) denial of a preauthorization request for work hardening for an injured worker’s compensation claimant (“Claimant”). American Casualty Insurance Company of Reading, Pennsylvania (“the Carrier”) preauthorized work conditioning services but argued against the mental health and vocational counseling components of work hardening. This decision […]
453-02-0686-m2
DECISION AND ORDER Hartford Insurance Company of the Midwest (“Carrier”) appeals a Texas Workers’ Compensation Commission’s Medical Review Division (“MRD”) decision in a preauthorization dispute. The MRD granted the preauthorization request filed by Lowell Haro, M.D., on behalf of an injured worker (“Claimant”) for an intra-discal electro-thermal procedure (“IDET”). This decision agrees with MRD, finding […]
453-02-2418-m2
DECISION AND ORDER Hartford Insurance Company (Carrier) requested a hearing from the decision of the Texas Workers’ Compensation Commission’s Medical Review Division (MRD) to approve the preauthorization request of the Suchowiecky Center (Provider) for thirty sessions of chronic pain management for ___, an injured worker. In this decision, the ALJ agrees with MRD and authorizes […]
453-02-1852-m2
DECISION AND ORDER Linden Dillin, M.D., challenges a decision of the Texas Workers’ Compensation Commission’s Medical Review Division (MRD) confirming the denial by American Home Assurance Company (AHAC) of his request to perform an arthroscopy on an injured worker. This decision finds the requested procedure is reasonable, is medically necessary, and should be authorized. I. […]
453-02-2297-m2
DECISION AND ORDER ___, an injured worker (Petitioner), has appealed a decision of the Medical Review Division (MRD) of the Texas Workers Compensation Commission (Commission). MRD denied preauthorization for the reasonable and necessary costs for a repeat lumbar MRI. In this decision, the Administrative Law Judge finds that Petitioner has shown that the requested repeat […]
453-02-0036-m2
DECISION AND ORDER The claimant ______is seeking preauthorization for ambulatory surgical center care for a right carpal tunnel decompression and Guyon’s[1] canal release surgery. The carrier, Twin City Fire Insurance Company (the Carrier), denied preauthorization because, in its view, the objective medical evidence did not demonstrate a need for the procedure. The Texas Workers’ Compensation […]
453-02-1664-m2
DECISION AND ORDER Harris County 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 ambulatory surgical center care to provide___, an injured worker, with a permanent spinal cord stimulator and related treatment. In this decision, the Administrative […]
453-03-2175-m2
DECISION AND ORDER John A. Sazy, M.D. (Provider), challenged the decision of Lumberman’s Mutual Casualty Company (Carrier) denying preauthorization for a CT myelogram and EMG for ___ (Claimant). In this decision, the Administrative Law Judge (ALJ) finds that Provider met its burden of showing that the requested procedures are reasonable and necessary medical care and […]