453-03-2920-m5
DECISION AND ORDER Injured worker________[1] (Claimant) has appealed a decision of the Medical Review Division (MRD) of the Texas Workers= Compensation Commission (the Commission) denying reimbursement of $323.00 she paid for immunotherapy and intradermal skin tests provided to her from June 15, 2001, through September 7, 2001, by her treating physician. The MRD’s denial of […]
453-05-4991-m5
DECISION AND ORDER I. DISCUSSION Ernie V. Fields, D.C. (Petitioner) requested a hearing to contest the Findings and Decision of the Texas Workers’Compensation Commission (Commission) denying Petitioner reimbursement from South Plains School Worker’s Compensation Program (Respondent) for work conditioning. Petitioner also disputed the decision of the independent review organization (IRO), Envoy Medical Systems, L.P., that […]
453-01-3456-m5
DECISION AND ORDER This case is a dispute over whether National Union Fire Insurance Company of Pittsburgh Pa. (Carrier) should pay a claim filed by Back & Joint Clinic (Clinic) for services performed on an injured worker (Claimant) from June 19, 1999, through February 2, 2000. The Texas Workers’ Compensation Commission (Commission) Medical Review Division […]
454-10-3201-m5
DECISION AND ORDER Petitioner Injury 1 Treatment Center (ITC) seeks reimbursement of $12,352.00 for work hardening services it provided the Claimant, ____. The Administrative Law Judge (ALJ) finds the Carrier, ____, Self Insurance Fund (___SIF), should reimburse ITC the full amount, and so orders. I. HISTORY, NOTICE, AND JURISDICTION The Claimant sustained a compensable work-related […]
454-09-3006-m5
DECISION AND ORDER __(__) seeks relief from an order of the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC), requiring it to reimburse Horizon Health (Horizon) $14,398.29 for treatment provided to an injured city employee (Claimant) during 2004. The Administrative Law Judge (ALJ) concludes __ proved the treatment […]
454-08-2766-m5
DECISION AND ORDER Petitioner Ark-La-Tex Health Center, Inc. (ALTHC) seeks reimbursement of $6,626.00 for spinal manipulation therapy and electrical stimulation it provided the Claimant, ___, during 2006. The Administrative Law Judge concludes ALTHC proved the medical necessity of the spinal manipulation therapy, but not that of the electrical stimulation. He orders reimbursement of $4,806.00, which […]
454-08-3847-m5
DECISION AND ORDER Safety National Casualty Corporation (Carrier) appealed from an adverse Medical Dispute Resolution decision issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division) ordering it to reimburse Dallas Multidisciplinary Clinic/Dallas Integrated Healthcare (Provider) for physical therapy services rendered between January 9, 2006, and March 15, 2006, for Claimant ____. A […]
454-08-3848-m5
DECISION AND ORDER From June 26, 2007, through August 29, 2007, Petitioner, Texas Health, L.L.C., a CARF-accredited facility,[1] provided work hardening services to a workers’ compensation claimant. Respondent, Dallas National Insurance Company, determined that the treatment was not medically necessary. The amount in dispute is $6,228.80 for 11 visits in a four-week period and related […]
454-08-4471-m5
DECISION AND ORDER I. INTRODUCTION Gabriel Gutierrez (Petitioner and Provider) appealed the decision of the Medical Dispute Resolution Division of the Texas Department of Insurance, Division of Workers’ Compensation (the Division) regarding services provided by Petitioner to a workers’ compensation claimant, ___ (Claimant) from March 14, 2006, through April 28, 2006. The Medical Review Division […]
454-08-1436-m5
DECISION AND ORDER On April 11, 2008, before the scheduled hearing in this case, Respondent Liberty Mutual Insurance Company (LMIC) filed its Motion to Dismiss for Lack of Jurisdiction. The Administrative Law Judge (ALJ) concludes that motion should be granted, this case should be dismissed with prejudice from the docket of the State Office of […]