453-04-8364-m2
DECISION AND ORDER Steven S. Callahan, Ph.D. (Provider) appealed the decision of the Texas Workers’ Compensation Commission (Commission) designee, an Independent Review Organization (IRO), which denied his request for preauthorization for four hours[1] of psychological testing as not medically necessary. The Administrative Law Judge (ALJ) finds that Provider proved that the psychological testing is medically […]
453-02-2302-m2
DECISION AND ORDER Socorro I.S.D. (Carrier) challenged the decision of the Texas Workers’ Compensation Commission (the Commission) Medical Review Division (MRD) granting preauthorization for arthroscopic decompression of right shoulder (shoulder surgery) for ___ (Claimant), an injured worker. In this decision, the Administrative Law Judge (ALJ) finds that Carrier met its burden of proving the requested […]
453-05-2405-m2
DECISION AND ORDER Great American Alliance 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- 05-0052-01, granting preauthorization to Shahid Rashid, M.D. (Provider) for a 30-session chronic pain management program for a workers’ […]
453-05-2884-m2
DECISION AND ORDER ___ (Claimant) challenged the decision of TPS Joint Self Insurance Funds (Carrier) denying preauthorization for cervical facet joint injections with Lidocaine infusions. In this decision, the Administrative Law Judge (ALJ) finds that Claimant did not meet her burden of showing that the requested procedure is reasonable and necessary medical care and should […]
453-05-0116-m2
DECISION AND ORDER Claimant ___ requested a hearing on an Independent Review Organization’s (IRO) decision denying him preauthorization for a lumbar diskogram at levels L3-4 and L4-5. The IRO denied the requested diskogram because ___ previously had surgery at those lumbar levels and diskography after surgical intervention is usually not a valid procedure. After the […]
453-05-2923-m2
DECISION AND ORDER Connecticut Indemnity Company (Carrier) contested the decision of an Independent Review Organization (IRO) granting preauthorization for a chronic pain management program to a worker’s compensation Claimant. This decision finds that the Carrier failed to sustain its burden of proving that the program is not medically necessary; consequently, the treatments should be preauthorized. […]
453-04-3068-m2
DECISION AND ORDER First Rio Valley Medical, P. A., (Provider) challenges the decision by an Independent Review Organization (IRO) to deny preauthorization for ___ (Claimant) to receive forty sessions of a chronic pain management program. Travelers Indemnity Company of Connecticut (Carrier) denied the request as medically unnecessary and the IRO upheld that decision. The Administrative […]
453-05-1646-m2
DECISION AND ORDER I. Introduction American Casualty Company of Reading, PA (Carrier) has appealed a decision of an independent review organization (IRO) on behalf of the Texas Workers= Compensation Commission (TWCC). The decision concerned Carrier’s denial of the request of Jeffrey H. Charnov, M.D. (Dr. Charnov), for pre-authorization of medical services for ___ (Claimant). The […]
453-05-1027-m2
DECISION AND ORDER Shahid Rashid, M.D., seeks review of a decision by the Texas Workers’ Compensation Commission (Commission), acting through an independent review organization (IRO), preauthorizing Bilateral Cervical Medial Branch Block injections to a workers’ compensation claimant. This decision finds that Hidalgo County (Carrier) failed to show that the disputed services are not medically necessary […]
453-04-7041-m2
DECISION AND ORDER I.INTRODUCTION Hudspeth County (“petitioner”) challenged a decision by an Independent Review Organization (“IRO”), issued on behalf of the Texas Workers’ Compensation Commission (“commission”) in a preauthorization dispute. The IRO found that Petitioner improperly denied preauthorization for a total knee replacement, intended to provide relief for ___ (“respondent”), a claimant suffering from a […]