453-02-1690-m2
DECISION AND ORDER Great American Assurance Company (Carrier) appealed the findings of the Texas Workers’ Compensation Commission’s Medical Review Division (MRD) which approved The Suchowiecky Center’s (Provider) request for preauthorization for thirty sessions of chronic pain management. This decision agrees with the MRD and authorizes ___ (Claimant) to receive thirty sessions of chronic pain management […]
453-02-2014-m2
DECISION AND ORDER I. Introduction The University of Texas System (Carrier) has appealed a decision of the Texas Workers’ Compensation Commission (TWCC) Medical Review Division (MRD). MRD directed the Carrier to pay the reasonable and necessary costs of a repeat lumbar magnetic resonance image (Repeat MRI) for___ (Claimant). The only disputed issue is whether the […]
453-02-1854-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 outpatient carpal tunnel release surgery on Petitioner. In this decision, the Administrative Law Judge finds that Petitioner has shown that […]
453-02-1174-m2
DECISION AND ORDER Southwest Independent School District (Southwest or Petitioner), appealed the decision of the Texas Workers’ Compensation Commission’s Medical Review Division (MRD) preauthorizing a chronic pain management program (CPM) requested by Brad Burdin, D.C. (Provider), for _____(Claimant). Dr. Burdin claimed the CPM program was necessary to treat Claimant’s debilitating pain, related depression, and difficulties […]
453-02-0959-m2
DECISION AND ORDER Chuck Tillotson, D.C. (Petitioner) requested a hearing to challenge a decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (the Commission). The MRD decision denied preauthorization for physical therapy and other treatment for J.T. (the Claimant) because the medical documentation submitted did not support the medical necessity of […]
453-01-1077-m2
DECISION AND ORDER This dispute arose as a result of health care treatments and services provided by Beacon Health, Ltd. and Neurobehavioral Resources (collectively NHS)[1] to P.B., a police officer, of the City of Houston (City), who sustained a work-related traumatic brain injury on__________. The City is a self-insured provider of workers’ compensation. The services […]
453-02-0509-m2
DECISION AND ORDER I. Summary The Respondent Curtis Adams, D.C., sought preauthorization under two CPT codes from the Petitioner St. Paul Fire & Marine Insurance Company for physical therapy for the patient____. The Petitioner gave partial approval, approving treatment under one of the CPT codes, but not the other. The Respondent made a request for […]
453-02-0960-m2
DECISION AND ORDER Petitioner, North Forest Independent School District (Carrier), appealed the Findings and Decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division (MRD) in a preauthorization dispute. The MRD decision authorized ambulatory surgical center (ASC) care as requested by Anthony J. LaMarra (the Provider) to perform a left ankle arthroscopy with possible […]
453-02-1286-m2
DECISION AND ORDER I. Introduction Travelers Indemnity Company of Connecticut (Carrier) has appealed a decision of the Texas Workers’ Compensation Commission (TWCC) Medical Review Division (MRD) preauthorizing and ordering Carrier to pay the reasonable and necessary costs to removes a lesion mass in the wrist of ____ (Claimant) that resulted from a compensable injury. Specifically, […]
453-02-0373-m2
DECISION AND ORDER American Home Assurance Company (Carrier) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division (MRD) that authorized intradiscal electro thermal therapy (IDET) at an ambulatory surgical center for ___ (___or Claimant), an injured worker. MRD determined IDET for Claimant was reasonably required within the meaning of the Texas […]