453-05-4321-m2
DECISION AND ORDER Petitioner, American Home Assurance Company, (Carrier) appealed the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC) granting preauthorization for an injured worker (Claimant) to receive ten sessions of a chronic pain management program at the request of Dean McMillan, M.D. (Provider). The Administrative Law […]
453-05-6512-m2
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) requested a hearing on a decision by an Independent Review Organization (IRO) granting preauthorization to Nestor Martinez, D.C.,[1] (Provider) for a work hardening program for the injured worker ___ (Claimant). After considering the evidence and arguments, the Administrative Law Judge (ALJ) concludes that Carrier has shown that […]
453-05-4883-m2
DECISION AND ORDER Petitioner, the State Office of Risk Management (Petitioner), appealed a decision of an independent review organization (IRO) designated by the Texas Workers= Compensation Commission (Commission), in which an IRO doctor determined 15 additional sessions (120 hours) in a pain management program constituted medically necessary treatment for Claimant ___ (Claimant) and should be […]
453-05-5820-m2
DECISION AND ORDER Debbie Crawford, D.O., (Provider) challenges the decision of the Independent Review Organization (IRO) denying her preauthorization request for 20 sessions of work hardening for injured worker ___(Claimant). After considering the evidence presented, the Administrative Law Judge (ALJ) concludes that Provider has not shown by a preponderance of the evidence that Claimant is […]
453-05-5356-m2
DECISION AND ORDER Claimant__ requested a hearing on an Independent Review Organization’s (IRO) decision denying him preauthorization for an IDET surgical procedure in his lumbar spine.[1] The IRO denied the requested surgery because ___had an inconclusive discogram study. This decision agrees with the IRO and concludes that the requested IDET surgery is not medically reasonable […]
453-05-3170-m2
DECISION AND ORDER Millennium Chiropractic and Scoliosis Center (Petitioner) requested a hearing before the State Office of Administrative Hearings following a decision of the Texas Workers’ Compensation Commission (Commission) acting through Medical Review of Texas, an Independent Review Organization (IRO). The Commission’s Order denied Petitioner’s preauthorization request for an 8-week work hardening program based upon […]
453-05-5464-m2
DECISION AND ORDER National Fire Insurance Company of Hartford (Carrier) denied preauthorization for a lumbar discogram requested by Madhavan Pisharodi, M.D. (Provider) for Claimant. The dispute was referred to an Independent Review Organization (IRO), which authorized the procedure. In this decision, the Administrative Law Judge (ALJ) finds that Carrier proved by a preponderance of the […]
453-05-5251-m2
DECISION AND ORDER Pisharodi Clinic (Provider) challenged the decision of Federated Mutual Insurance Company (Carrier), denying preauthorization for a lumbar discogram (discogram). The dispute was referred to an Independent Review Organization (IRO), which denied authorization for the procedure. In this decision, the Administrative Law Judge (ALJ) finds that Provider did not meet its burden of […]
453-05-4989-m2
DECISION AND ORDER Texas Mutual Insurance Company (Petitioner) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) designee, an independent review organization (IRO) which granted a request by Behavioral Healthcare Associates (Respondent) for preauthorization of a chronic pain management (CPM) program for a workers’ compensation claimant (Claimant). Petitioner’s denial was based on its finding […]
453-05-5353-m2
DECISION AND ORDER The issue in this case is whether electromyographic (EMG) guided Botox injections should be preauthorized to treat the compensable work injury of ___ (Claimant). The Administrative Law Judge (ALJ) disagrees with the decision of the Independent Review Organization (IRO) and issues this decision and order preauthorizing the injections. I. DISCUSSION On ___, […]