453-05-4907-m5
DECISION AND ORDER I. STATEMENT OF CASE Patrick R. E. Davis, D.C., (Petitioner/Provider) disputes the decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission[1] in a dispute regarding medical necessity for physical medicine procedures provided to __(Claimant). The IRO found that American Home Assurance Company (Respondent/Carrier) properly denied reimbursement […]
453-05-3338-m5
SOAH DOCKET NO. 453-05-3338.M5 MR NO. M5-05-0045-01 LAURENCE N. SMITH, D.C., § BEFORE THE STATE OFFICE Petitioner § § V. § OF § LIBERTY MUTUAL FIRE INSURANCE, § Respondent §ADMINISTRATIVE HEARINGS I. DECISION AND ORDER Laurence N. Smith, D.C. (Provider), appealed the decision of the Texas Workers’ Compensation Commission’s Medical Review Division (MRD).[1] The MRD […]
453-05-5824-m5
DECISION AND ORDER I. INTRODUCTION Pain & Recovery Clinic (Provider) disputes a decision of an independent review organization (IRO) on behalf of the Texas Workers= Compensation Commission (TWCC) Medical Review Division (MRD) regarding certain medical services for __(Claimant). The IRO agreed with Bankers Standard Insurance Co. (Carrier) and found that those medical services were not […]
453-05-2144-m5
DECISION AND ORDER Highpoint Pharmacy (Petitioner) seeks reimbursement of $1,252.40 for prescriptions provided to a workers’ compensation claimant (Claimant). The Texas Workers’ Compensation Commission (Commission)[1], acting through an independent review organization (IRO), denied reimbursement on the basis that the services were not medically necessary. This decision also denies the requested reimbursement. I. NOTICE, JURISDICTION, AND […]
453-05-2763-m5
DECISION AND ORDER This is a dispute over reimbursement for an individual psychotherapy session. The Administrative Law Judge (ALJ) orders reimbursement for the session, which was conducted August 12, 2004. I. FACTUAL AND PROCEDURAL HISTORY The workers’ compensation claimant, ___ (the Claimant), sustained a compensable injury to her ankle ___, and was terminated from her […]
453-05-4779-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) has challenged a decision of the Medical Review Division (MRD) of the Texas Workers= Compensation Commission (Commission)[1] in a dispute regarding the medical necessity of physical therapy services provided by Orthopedic Institute of Texas (Provider) to an injured claimant between November 17 and December 11, 2003. The […]
453-05-4351-m5
DECISION AND ORDER Texas Hospital Insurance Exchange (ACarrier) has challenged decisions by an independent review organization (AIRO) and by the Medical Review Division (AMRD) of the Texas Workers= Compensation Commission (ACommission)[1] in a dispute primarily regarding medical necessity for chiropractic treatment. The IRO and MRD found that the Carrier improperly denied reimbursement for some of […]
453-05-1229-m5
DECISION AND ORDER Danny Bartel, M.D., challenges the decision of the Texas Workers’ Compensation Commission (Commission),[1] acting through an independent review organization (IRO), in a dispute regarding the medical necessity of injections provided to Claimant__. This decision finds largely in favor of Dr. Bartel. I. PROCEDURAL HISTORY, NOTICE, AND JURISDICTION The hearing on the merits […]
453-05-3189-m5
DECISIONAND ORDER Rehab 2112 (Petitioner) has challenged the decision of an Independent Review Organization (IRO) upholding a decision by Hartford Underwriters Insurance Company (Respondent) denying Petitioner reimbursement, on the basis of medical necessity, for work hardening and related services provided Claimant ___ (Claimant) between August 20 and September 24, 2003 (collectively, the disputed services).[1] The […]
453-05-4090-m5
DECISION AND ORDER I. STATEMENT OF CASE Texas Imaging & Diagnostic Center (Petitioner/Provider) disputes the decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission[1] in a dispute regarding medical necessity for two lumbar epidural steroid injections provided to__. (Claimant). The IRO found that American Guaranty & Liability Company (Respondent/Carrier) […]