453-05-7856-m2
DECISION AND ORDER I. INTRODUCTION ___ (Claimant) disputes a decision of an independent review organization (IRO), on behalf of the Texas Workers’ Compensation Commission (TWCC), concerning the pre-authorization of a medical service for the Claimant. The IRO agreed with Zurich American Insurance Company (Carrier) and did not find that the requested service is reasonably medically […]
453-05-7743-m2
DECISION AND ORDER American Home Assurance Company (American Home) requested a hearing to contest an independent review organization (IRO) determination, issued on behalf of the Texas Workers’ Compensation Commission (Commission), concluding that a lumbar discogram requested by Robert J. Henderson, M.D., for an injured worker (Claimant) was medically necessary and should be pre-authorized. Dr. Henderson […]
453-05-3171-m2
DECISION AND ORDER _____ (Claimant) appealed an Independent Review Organization (IRO) decision that recommended denial of pre-authorization of a lumbar CT/discogram at L3-4, L4-5, and L5-S1. The IRO concluded the injections were not medically necessary. This decision agrees with the IRO and concludes that the requested treatment is not medically reasonable and necessary to treat […]
453-05-2673-m2
DECISION AND ORDER I. INTRODUCTION ___ (Claimant) disputes a decision of an independent review organization (IRO) on behalf of the Texas Workers= Compensation Commission (TWCC). The IRO agreed with Zurich American Insurance Company (Carrier) and found that an item of durable medical equipment (DME) that RS Medical (Provider) provided to the Claimant was not reasonably […]
453-05-3135-m2
DECISION AND ORDER Workers= compensation insurance claimant _____ (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 Dallas Fire Insurance Company (Carrier) to deny the requested procedure on the basis that it was not medically necessary. This decision finds […]
453-05-3134-m2
DECISION AND ORDER This case concerns a request for preauthorization for a thirty-session outpatient pain management multi-disciplinary program, five times a week for six weeks. The ALJ agrees with the workers’ compensation carrier and declines to order preauthorization. I. DISCUSSION The Claimant, ___, was injured on ___,[1] when she tripped over a cushion and landed […]
453-05-5821-m2
DECISION AND ORDER Workers’ compensation claimant ___ (the Claimant) seeks preauthorization for a thoracic and lumbar myelogram with post CT scan. The Administrative Law Judge (ALJ) concludes the Claimant did not prove the procedure was medically necessary. He therefore does not order preauthorization. I. DISCUSSION The Claimant originally suffered a compensable injury to his back […]
453-05-5534-m2
DECISION AND ORDER ___ (Claimant) appealed an Independent Review Organization (IRO) decision denying preauthorization of a lumbar epidural steroid injection (ESI). This decision concludes that requested service is medically necessary and should be preauthorized. I.JURISDICTION & HEARING Because there were no challenges to notice or jurisdiction, those matters are set forth in the findings of […]
453-05-6611-m2
DECISION AND ORDER Old Republic Insurance Company (Carrier) appealed the decision of Maximus, an independent review organization certified by the Texas Department of Insurance, in Texas Workers= Compensation Commission (TWCC) Medical Review Division tracking number M2-05-0976-01, granting preauthorization to Fort Worth Healthcare Systems[1] (Provider) for a 10-session chronic pain management program for a workers= compensation […]
453-05-6899-m2
DECISION AND ORDER Ms. ___ (“Petitioner”), an injured claimant, has challenged the decision of an independent review organization (“IRO”) acting on behalf of the Texas Workers’ Compensation Commission (“Commission”) in a dispute regarding preauthorization for a lumbar myelogram with CT scan. The IRO found that the proposed procedure was not medically necessary and that the […]