453-05-4089-m2
DECISION AND ORDER North Texas Pain & Recovery Clinic (NTPRC) requested a hearing on an Independent Review Organization’s (IRO) decision denying preauthorization for a workers= compensation claimant (___) to receive fifteen additional days of pain management services. The IRO denied the request, noting that ___had already received fifteen days of these services but showed no […]
453-05-9245-m2
DECISION AND ORDER American Home Assurance Co. (Carrier) challenged the decision of an Independent Review Organization (IRO) granting preauthorization for ten sessions of a chronic pain management (CPM) program requested by Bexar County Healthcare Systems (Provider) for _____ (Claimant). In this decision, the Administrative Law Judge (ALJ) finds that Carrier met its burden of proving […]
453-05-2406-m2
DECISION AND ORDER ___,[1] (Claimant) contested an independent review organization (IRO) decision, issued on behalf of the Texas Workers’ Compensation Commission (Commission), concluding that a requested lumbar discogram with CT scan (discogram) was medically unnecessary. The Claimant’s employer’s workers’ compensation insurer, Zurich American Insurance Company (Carrier), contended the discogram was unnecessary because all other possible […]
453-05-0851-m2
DECISION AND ORDER I. Introduction Service Lloyds Insurance Company (Carrier) has appealed a decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission (Commission). The decision concerned Carrier’s denial of the request of Alliance Pain Centers (Alliance or Provider) for preauthorization of medical services for ___ (Claimant). The IRO found […]
453-05-1227-m2
DECISION AND ORDER Houston I.S.D. (Carrier) challenged the decision of an Independent Review Organization (IRO) granting preauthorization for 20 sessions of a chronic pain management (CPM) program for Claimant. In this decision, the Administrative Law Judge (ALJ) finds that Carrier met its burden of proving the requested CPM program is not reasonable and necessary medical […]
453-04-1449-m2
DECISION AND ORDER ___[1] contested a Texas Workers’ Compensation Commission (Commission) Medical Review Division (MRD) decision, dismissing her request for medical dispute resolution because ___ failed to comply with a Commission rule requiring that she file her request within 45 days after the insurance carrier denied approval of her request for reconsideration of the treatment.[2] […]
453-05-2882-m2
DECISION AND ORDER Bexar County Healthcare Systems (Bexar) appealed a decision by an independent review organization (IRO), on behalf of the Texas Workers’ Compensation Commission (Commission), concluding that a requested ten sessions of a chronic pain management program was medically unnecessary. The Administrative Law Judge (ALJ) concludes the appeal should be denied because the Claimant’s […]
453-05-1541-m2
DECISION AND ORDER ___ (Claimant) challenged the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission) denying preauthorization for the purchase of supplies to use of a muscle stimulator (MS) unit. The MRD concluded that the MS unit and supplies were not medically necessary to treat Claimant. Claimant failed to […]
453-05-0578-m2
DECISION AND ORDER American Home Assurance Co., (Carrier) appealed the decision of an Independent Review Organization (IRO) authorizing right carpal tunnel release with right ulnar nerve transposition (wrist surgery) for Claimant, __The Administrative Law Judge (ALJ) finds that this matter has previously been adjudicated before the State Office of Administrative Hearings (SOAH) and that Carrier […]
453-05-3659-m2
DECISION AND ORDER Town East Rehabilitation (“Petitioner”), has challenged a determination by the Texas Workers’ Compensation Commission’s Medical Review Division (“MRD”) in a dispute regarding preauthorization for a chronic pain management program. The MRD found that Petitioner’s case should be dismissed because Petitioner failed to make a timely request for reconsideration after New Hampshire Insurance […]