453-05-2106-m5
DECISION AND ORDER This case is a cross-appeal of two decisions: one from an independent review organization (IRO) and the other from the Medical Review Division of the Texas Workers’ Compensation Commission (MRD).[1] The IRO found that office visits, therapeutic procedures, group therapeutic procedures, manipulation, massage, tests, traction and supplies from August 1, 2003, through […]
453-05-2761-m5
DECISION AND ORDER The issues regarding this matter were previously litigated and decided by the State Office of Administrative Hearings (SOAH) in Docket No. 453-04-3601.M5. Accordingly, the Administrative Law Judge (ALJ) finds that the doctrine of res judicata applies and adopts the findings in Docket No. 453-04-3601.M5. Liberty Insurance Corporation (Carrier) should reimburse Central Dallas […]
453-05-3201-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) in a dispute regarding the medical necessity of chiropractic services provided by Daniel Buentello, D.C., and Neuromuscular Institute of Texas (collectively, Provider) to an injured claimant between May 29 and […]
453-04-1810-m5
DECISION AND ORDER American Home Assurance Company (AHAC) challenges the decision of the Texas Workers’ Compensation Commission (Commission), acting through an independent review organization (IRO), in a dispute regarding the medical necessity of physical medicine treatments provided to Claimant ___. The Administrative Law Judge (ALJ) finds partially in favor of AHAC. I. PROCEDURAL HISTORY, NOTICE, […]
453-05-1695-m5
DECISION AND ORDER This case is an appeal by Real Health Care (Provider) from a decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission[1] in a dispute regarding medical necessity for office visits and chiropractic treatment. The IRO found that the Metropolitan Transit Authority of Harris County (Carrier) properly […]
453-05-2840-m5
DECISION AND ORDER Texas Mutual Insurance Company (Texas Mutual) requested a hearing to contest an independent review organization (IRO) determination, issued on behalf of the Texas Workers’ Compensation Commission (Commission), concluding that certain office visits, electrical stimulation (unattended), electrical stimulation, ultrasound, massage, therapeutic exercises, shock wave therapy, and iontophoresis, provided from September 2, 2003, through […]
453-05-2933-m5
DECISION AND ORDER Southeast Health Services, Inc. (Petitioner) requested a hearing to contest a Texas Workers’ Compensation Commission (Commission) Medical Review Division (MRD) decision, issued on the basis of an independent review organization (IRO) determination that certain services provided to an injured worker from September 3, 2003, through September 23, 2003, were medically unnecessary. ___ […]
453-04-8358-m5
DECISION AND ORDER The issue in this case is the medical necessity of services performed for a workers’ compensation claimant from November 11, 2003, through December 30, 2003. The Administrative Law Judge (ALJ) finds the services were medically necessary and orders reimbursement. I. FACTUAL AND PROCEDURAL HISTORY Workers’ compensation claimant ___ (the Claimant) sustained a […]
453-05-2039-m5
DECISION AND ORDER This case is an appeal by West Belt Medical, P.L.L.C. (Provider) from a decision of an independent review organization (IRO) on behalf of the Texas Department of Insurance, Division of Workers’ Compensation (formerly, the Texas Workers’ Compensation Commission) in a dispute regarding medical necessity for chiropractic treatment. The IRO found that Service […]
453-05-2810-m5
DECISION AND ORDER I. Introduction Tarrant County Chiropractic and Rehabilitation (Provider or Tarrant County Chiropractic) challenges a decision of the Texas Workers’ Compensation Commission’s (TWCC or Commission) Medical Review Division (MRD),[1] regarding certain medical services that Tarrant County Chiropractic provided ___ (Claimant) from July 14, 2003, through December 10, 2003. MRD, relying on a determination […]