453-05-0935-m2
DECISION AND ORDER Workers’ compensation claimant ___ (the Claimant) seeks preauthorization for CPT code 27446, left knee arthroplasty and unicondylar replacement. The Administrative Law Judge (ALJ) concludes the Claimant proved the procedure was medically necessary and orders preauthorization. I. DISCUSSION The Claimant suffered a compensable injury to his left knee on ___. He had injured […]
453-05-0983-m2
DECISION AND ORDER Clifford Rogers, D.C., contested an independent review organization (IRO) decision, issued on behalf of the Texas Workers’ Compensation Commission (Commission), concluding that certain requested work hardening sessions were medically unnecessary and should not be preauthorized. The workers’ compensation insurer for the injured worker (Claimant), Hartford Insurance Company of the Midwest (Hartford), had […]
453-05-3285-m2
DECISION AND ORDER American Home Assurance Co., (Carrier) appealed the decision of an Independent Review Organization (IRO) authorizing a work hardening program for Claimant ___ The work hardening program was recommended by Provider, Eric Vanderwerff, D.C. The Administrative Law Judge (ALJ) finds that Carrier did not meet its burden of showing that the requested work […]
453-05-4447-m2
DECISION AND ORDER The issue in this case is whether a lumbar discogram with CT scan of the Claimant’s spine should be preauthorized. The Administrative Law Judge (ALJ) finds that the requested procedure should be preauthorized. I. JURISDICTION, NOTICE, AND PROCEDURAL HISTORY ALJ Kerry D. Sullivan held the hearing on this matter on March 29, […]
453-05-3136-m2
DECISION AND ORDER Jacob Rosenstein, M.D., (Provider) challenges the decision by an Independent Review Organization (IRO) denying his request to preauthorize a lumbar discogram for an injured worker (Claimant). Onebeacon Insurance Company (Carrier) denied the request as medically unnecessary and the IRO upheld that decision. The Administrative Law Judge (ALJ) agrees with the IRO and […]
453-04-6381-m2
DECISION AND ORDER ___ (Claimant) challenged the decision of American Home Assurance (Carrier), denying preauthorization for carpel tunnel release procedures of Claimant’s left and right wrists. In this decision, the Administrative Law Judge (ALJ) finds that Claimant did not meet her burden of showing that the requested procedures are reasonable and necessary medical care and […]
453-04-3773-m2
DECISION AND ORDER Continental Casualty Company (Carrier) refused to preauthorize a chronic pain management program (CPM) requested by First Rio Valley Medical, P.A.[1] (Petitioner) for a workers= compensation insurance claimant (Claimant). The denial was upheld in a decision issued by the Texas Workers= Compensation Commission’s (TWCC) Medical Review Division (MRD), which decision was based on […]
453-05-4142-m2
DECISION AND ORDER American Home Assurance Company (Carrier) appealed the decision of the Texas Workers= Compensation Commission (Commission) designee, an Independent Review Organization (IRO), which granted preauthorization for a discogram. In this case, Carrier failed to prove that the discogram was not medically necessary. The Administrative Law Judge (ALJ) finds that the discogram is medically […]
453-04-8327-m2
DECISION AND ORDER R.S. Medical (Petitioner) appealed the decision of the Texas Workers= Compensation Commission’s (Commission) designee, an independent review organization (IRO), in MDR Docket No. M2-04-1355-01, which upheld the denial by the City of Carrollton (City) of preauthorization of the indefinite rental or purchase of a medical device called a RS-4i for use by […]
453-05-3768-m2
DECISION AND ORDER This is a dispute over a request for preauthorization for a lumbar discogram. The Administrative Law Judge (ALJ) concludes the request should be denied. I. HISTORY The Claimant, ___, suffered a compensable injury to her back on ___. After more conservative treatment failed, she underwent a laminectomy on July 18, 2002. Although […]