453-05-2040-m5
DECISION AND ORDER Zurich American Insurance Company (Carrier) requested a hearing to contest a Medical Review Division (MRD) Decision ordering Carrier to reimburse Central Dallas Rehabilitation (Provider) for disputed work hardening and related services. The MRD decision was based in part on an independent review organization (IRO) determination, issued on behalf of the Texas Workers’ […]
453-05-4091-m5
DECISION AND ORDER Trinity Phy-Med, L.L.C., (Provider) challenged the decision of the Independent Review Organization (IRO) denying reimbursement for medical treatment provided to an injured worker (Claimant) whose employer was covered by workers compensation insurance provided by Texas Mutual Insurance Company (Carrier). Prior to the evidentiary hearing, Carrier filed a Motion for Summary Disposition (Motion) […]
453-05-3364-m5
DECISION AND ORDER I. SUMMARY JCMLR, P.A. (Alamo Healthcare), the Provider, appealed the decision of Texas Medical Foundation, an independent review organization (IRO), in Texas Workers= Compensation Commission (TWCC)[1] Medical Review Division (MRD) tracking number M5-04-3521-01, denying reimbursement for medical services provided to the Claimant. This decision orders that Texas Mutual Insurance Company, the Carrier, […]
453-05-4125-m5
DECISION AND ORDER This case concerns the medical necessity of medical services and durable medical equipment provided by Petitioner Patrick R. Davis, D.C., to J.H., a workers’ compensation claimant (the Claimant) from September 2, 2003, through December 19, 2003.The amount in dispute is $12,255.13. The Administrative Law Judge (ALJ) finds some services provided from November […]
453-05-4187-m5
DECISION AND ORDER I. INTRODUCTION This case presents a challenge by Waco Ortho Rehab (Provider) to a decision of an independent review organization (IRO) on behalf of the Texas Workers= Compensation Commission (Commission or TWCC)[1] in a dispute regarding medical necessity for chiropractic treatment. The IRO found that the insurer, Texas Mutual Insurance Company (Carrier), […]
453-05-4279-m5
DECISION AND ORDER I. INTRODUCTION McAllen Work Rehabilitation Center appealed a decision by the Texas Workers= Compensation Commission’s Medical Review Division (MRD) that ordered reimbursement for four weeks of a work hardening program but denied reimbursement for the following four weeks of the program. As reflected in the Findings of Fact and Conclusions of Law, […]
453-05-1458-m5
DECISION AND ORDER Jack P. Mitchell, D. C. (Provider), challenged the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC or Commission)[1] denying reimbursement to him for a variety of rehabilitation services and office visits provided to ___ (Claimant) between June 20, 2003, and December 29, 2003. The MRD determined […]
453-05-4543-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier ) appealed the decision of the Texas Workers= Compensation Commission’s (Commission) Medical Review Division (MRD)[1] to adopt the decision of its designee, an Independent Review Organization (IRO), which granted reimbursement for services provided a workers= compensation claimant (Claimant) by Premier Physical Therapy (Provider). Carrier claimed that the […]
453-05-4144-m5
DECISION AND ORDER The provider, First Rio Valley Medical, P.A. (First Rio), sought reimbursement for approximately two weeks of office visits, aquatic exercise, and massage therapy provided to claimant __in early 2004. Citing a lack of medical necessity, the carrier, Texas Workers Compensation Solutions (TWCS), declined to pay for the disputed services. An Independent Review […]
453-05-3753-m5
DECISION AND ORDER Petitioner, George C. Wilson, D.C. (Provider) appealed the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers= Compensation Commission (TWCC)[1] denying reimbursement from the City of Fort Worth (City) for medical services rendered to an injured worker (Claimant). The City provided workers= compensation coverage for its workers through […]