453-05-5822-m5
DECISION AND ORDER I. SUMMARY OF DECISION Fidelity & Guaranty Insurance Company (FGIC or Petitioner) requested a hearing following the issuance on April 7, 2005 of the Findings and Decision of the Texas Workers’ Compensation Commission (Commission). The Commission’s Findings and Decision relied upon a decision of an Independent Review Organization (IRO), and ordered reimbursement […]
453-04-8367-m5
DECISION AND ORDER I. DISCUSSION In SOAH Docket No. 453-04-8367.M5, Main Rehab & Diagnostic (MR&D), on August 2, 2004, requested a hearing following a July 16, 2004 Findings and Decision of the Texas Workers’ Compensation Commission (Commission). The Commission’s July 16, 2004 Findings and Decision relied upon a June 10, 2004 decision of Envoy Medical […]
453-05-2679-m5
DECISION AND ORDER I. DISCUSSION In SOAH Docket No. 453-04-8367.M5, Main Rehab & Diagnostic (MR&D), on August 2, 2004, requested a hearing following a July 16, 2004 Findings and Decision of the Texas Workers’ Compensation Commission (Commission). The Commission’s July 16, 2004 Findings and Decision relied upon a June 10, 2004 decision of Envoy Medical […]
453-05-4336-m5
DECISION AND ORDER Tarrant County Chiropractic & Rehabilitation (Provider) appealed the findings and decision of the Texas Workers’ Compensation Commission’s (Commission’s)[1] designee, an independent review organization, which found that the office visits and physical medicine treatments provided to__, a workers’ compensation claimant (Claimant), were not medically necessary health care. This decision finds that the treatments […]
453-05-4457-m5
DECISION AND ORDER I. DISCUSSION The workers’ compensation claimant in this case underwent a work hardening program in 2004. The carrier, St. Paul Travelers Insurance Co. (St. Paul), declined to reimburse the provider, Rehab 2112, LLC, (Rehab 2112) for the work hardening services. An Independent Review Organization (IRO) determined that the work hardening program was […]
453-05-4451-m5
DECISION AND ORDER The provider, SCD Back and Joint Clinic (SCD) sought reimbursement for five months of various medical and therapeutic services provided to claimant ___in ___ for a shoulder injury. The carrier, Texas A&M University (A&M), declined to pay for the disputed services. A&M cited a lack of medical necessity concerning most of the […]
453-05-5149-m5
DECISION AND ORDER Mark C. Sherrod, D.C. (Provider) contested the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (the Commission) declining to order reimbursement of $720.50 for chiropractic manipulative treatment, spinal, 3-4 regions (CPT Code 98941), electrical stimulation unattended (CPT Code G0283), mechanical traction (CPT Code 97012), manual therapy technique […]
453-05-4510-m5
DECISION AND ORDER Suhail S. Al-Sahli, D.C. (Dr. Al-Sahli) appeals a decision by the Texas Workers’ Compensation Commission’s (TWCC)[1] Medical Review Division (MRD) that denied reimbursement for chiropractic services provided to a workers’ compensation claimant (Claimant) between November 17, 2003, and August 12, 2004. Zurich American Insurance Company (Carrier) denied reimbursement based on lack of […]
453-05-1455-m5
DECISION AND ORDER I. Introduction American Home Assurance Company (Carrier) challenges a decision of the Texas Workers’ Compensation Commission’s (TWCC or Commission) Medical Review Division (MRD),[1] regarding medical services that Laurence N. Smith, D.C. (Dr. Smith or Provider), provided ___ (Claimant) from November 15, 2002, through February 27, 2003. An independent review organization (IRO) found […]
453-05-3152-m5
DECISION AND ORDER I. INTRODUCTION Texas Mutual Insurance Company (Carrier) disputes the decision of an independent review organization (IRO) issued on behalf of the Texas Workers’ Compensation Commission (TWCC or Commission)/Medical Review Division (MRD),[1] which directed Carrier to pay Alta HealthCare Clinic (Provider) for claims Carrier denied for lack of medical necessity (the disputed services).[2] […]