453-05-7243-m5
DECISION AND ORDER Lumbermens Mutual Casualty Company (Carrier) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[2] ordering additional reimbursement to Vista Medical Center Hospital (Provider) for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement for […]
453-05-9364-m5
DECISION AND ORDER American Protection Insurance Company (Carrier) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[2] granting additional reimbursement for a hospital stay provided to Claimant, an injured worker, by Vista Medical Center Hospital (Provider). Carrier argued that reimbursement for […]
453-05-9256-m5
DECISION AND ORDER Facility Insurance Corporation (Carrier) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[2] ordering additional reimbursement to Vista Medical Center Hospital (Provider) for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement for this […]
453-05-8030-m5
DECISION AND ORDER Liberty Mutual Insurance Company (Carrier) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[2] ordering additional reimbursement to Vista Medical Center Hospital (Provider) for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement for […]
453-05-9025-m5
DECISION AND ORDER Ace Insurance Company of Texas (Carrier) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[2] awarding additional reimbursement to Vista Medical Center Hospital (Provider) for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement […]
453-05-9162-m5
DECISION AND ORDER Facility Insurance Corporation (Carrier) and Memorial Hermann Hospital System (Provider) each requested a hearing on decisions by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division),[2] concerning requested reimbursement to Provider for a hospital stay provided to Claimant, an injured worker. There were three MRD […]
454-08-1702-m5
DECISION AND ORDER I. INTRODUCTION Dallas National Insurance Company (Carrier) challenges the decision of an Independent Review Organization (IRO) on behalf of the Texas Department of Insurance, Division of Worker’s Compensation, which found that work hardening was appropriate for a Claimant treated by DFW Workers Rehab (the Provider). This decision finds that the Carrier has […]
453-08-0788-m5
DECISION AND ORDER Job Injury Rehab Center, also known as Rehab 2112 (Provider), challenges the decision of an Independent Review Organization (IRO) upholding the decision of _____ (Carrier) to deny reimbursement for a work hardening program provided to an injured worker (Claimant). Because Provider failed to prove the program was medically necessary for the treatment […]
454-08-1156-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) requested a hearing to contest a medical fee dispute resolution order issued by the Texas Department of Insurance, Division of Workers’ Compensation (Division) regarding medical services provided to ____ (Claimant). At the hearing, Carrier appeared through its attorney. No other parties appeared or participated in the hearing. […]
454-09-0522-m5
DECISION AND ORDER Continental Casualty Company (Carrier) appealed the decision of the Medical Dispute Resolution Division (MDR) of the Texas Department of Insurance, Division of Workers’ Compensation (Division), ordering payment for a chronic pain management (CPM) program that Dennis Gutzman, M.D., provided to an injured worker (Claimant) from January 4, 2005, through March 2, 2005. […]