453-05-7319-m2
DECISION AND ORDER ___(Claimant) requested a hearing on the decision of the Independent Review Organization (IRO)[1] denying preauthorization for either a capsulotomy or capsulectomy (forms of breast surgery). After considering the evidence and arguments presented, the Administrative Law Judge (ALJ) concludes that Claimant has failed to show by a preponderance of the evidence that the […]
453-05-9435-m2
DECISION AND ORDER American Home Assurance Company (Carrier) requested a hearing on the decision of the Independent Review Organization (IRO)[1] granting preauthorization for a lumbar discogram and post-discogram CT scan. After considering the evidence and arguments presented, the Administrative Law Judge (ALJ) concludes that Carrier has shown by a preponderance of the evidence that the […]
453-05-8843-m2
DECISION AND ORDER Continental Casualty Co. (Carrier) filed this petition, challenging the decision of an Independent Review Organization (IRO) which granted preauthorization of a lumbar myelogram for workers= compensation insurance claimant, __(Claimant). The IRO found that the requested procedure was medically necessary. This decision finds that, based on the evidence presented during the hearing, the […]
453-05-8281-m2
DECISION AND ORDER Claimant filed this petition challenging the decision of an Independent Review Organization (IRO) denying preauthorization of a lumbar discogram. The IRO upheld the decision of Globe Indemnity Company (Carrier) to deny the requested procedure on the basis that it was not medically necessary. Based on the evidence presented during the hearing, the […]
453-05-6751-m2
DECISION AND ORDER Texas Mutual Insurance Company (the Carrier) challenges the decision of an Independent Review Organization (IRO) granting preauthorization for a twenty-session work hardening program for a workers’ compensation claimant.[1] I. PROCEDURAL HISTORY, NOTICE, AND JURISDICTION There are no contested issues of notice or jurisdiction in this proceeding, and these matters are addressed in […]
453-05-6480-m2
DECISION AND ORDER Bexar County Healthcare Systems (Provider) contests the decision of the Texas Workers’ Compensation Commission’s (Commission’s)[1] designee, an independent review organization (IRO), which denied pre-authorization for 10 sessions of chronic pain management for ___ (Claimant). This decision concludes that pre-authorization should be granted. I.PROCEDURAL HISTORY, NOTICE, AND JURISDICTION Administrative Law Judge (ALJ) Sharon […]
453-05-3138-m2
DECISION AND ORDER ___ (Claimant) challenges the decision of an Independent Review Organization (IRO) denying her request to preauthorize left shoulder arthroscopic surgery to remove possible loose cartilage. The Claimant’s employer at the time of her injury, ___ (the Carrier), is self insured under the workers’ compensation system and denied the claim as medically unnecessary. […]
453-05-7331-m2
DECISION AND ORDER ___ (Claimant) requested a hearing on the decision of the Independent Review Organization (IRO)[1] denying preauthorization for trigger point injections and a psoas compartment block. After considering the evidence and arguments presented, the Administrative Law Judge (ALJ) concludes that Claimant has failed to show by a preponderance of the evidence that the […]
453-05-6478-m2
DECISION AND ORDER ___ (Claimant) requested a hearing to contest an independent review organization (IRO) decision, issued on behalf of the Texas Workers’ Compensation Commission (Commission), that a magnetic resonance imaging (MRI) of his right shoulder was medically unnecessary. Ace Insurance Company of Texas Ace USA/ESIS (Ace), the workers’ compensation insurance carrier for the Claimant’s […]
453-05-7472-m2
DECISION AND ORDER I. DISCUSSION Arie Salzman, M.D., (Provider)[1] disputes a decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission (TWCC) which agreed with Texas Mutual Insurance Company’s (Carrier’s) decision to deny preauthorization to perform manipulation under anesthesia (MUA) on Claimant’s left fingers and thumb. The issue is whether […]