453-05-0859-m5
DECISION AND ORDER I. DISCUSSION Three dockets were joined for a hearing on the merits. The three dockets address the provision of chiropractic treatment services to injured worker ___ (Claimant) from January 2003 through June 2003. In SOAH Docket No. 453-05-0859.M5, Texas Mutual Insurance Company (TMIC) requested a hearing to contest the medical necessity of […]
453-05-2075-m5
DECISION AND ORDER Hartford Underwriters Insurance Company (Carrier) challenges the findings and decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (the Commission)[1] ordering Carrier to pay Respondent, North Texas Rehabilitation Center (Provider), for the following services: (1) work hardening on dates of service April 7 – 25, 2003; (2) a […]
453-04-8233-m5
DECISION AND ORDER Atlantis Healthcare Clinic (Provider) 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 to an injured claimant between August 20 and October 10, 2002. The MRD’s decision was based on the findings of […]
453-05-2036-m5
DECISION AND ORDER This is a dispute over reimbursement for services performed to treat an injury suffered by Claimant while in the course and scope of her employment. The Administrative Law Judge (ALJ) concludes that the disputed services should not be reimbursed because Southeast Health Services (Provider) failed to meet its burden to prove medical […]
453-04-8234-m5
DECISION AND ORDER EZ RX Pharmacy (Provider) appealed the decision of the Texas Workers’ Compensation Commission (Commission) designee, an Independent Review Organization (IRO), which denied its request for reimbursement for Celexa 20 mg., Ambien 10 mg., carisoprodol 350 mg., hydrocodone/apap 7.5/325 mg., and Coats aloe liniment (collectively, medications) from April 22, 2003, through April 24, […]
453-05-3199-m5
DECISION AND ORDER Real Health Care (Petitioner) seeks reimbursement of $4,975 for office visits, electrical stimulation, ultrasound, therapeutic procedures and activities, neuromuscular reeducation, massage, manual therapy technique, and mechanical traction provided to a worker’s compensation claimant from August 1, 2003 through March 26, 2004. The Texas Workers’ Compensation Commission (Commission), acting through an independent review […]
453-05-3339-m5
DECISION AND ORDER SCD Back and Joint Clinic, Ltd. (Petitioner) requested a hearing to contest the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Texas Medical Foundation, an Independent Review Organization (IRO), denying Petitioner reimbursement for chiropractic services performed on _____ (Claimant) for the period August 26, 2003, through October 8, […]
453-05-3187-m5
DECISION AND ORDER The Neuromuscular Institute of Texas (NIT) challenged the decision of the Texas Workers= Compensation Commission’s (Commission=s) Medical Review Division (MRD) denying reimbursement for physical medicine treatments provided to the Claimant _____. The Administrative Law Judge (ALJ) finds that the NIT failed to meet its burden of proof and is not entitled to […]
453-05-3218-m5
DECISION AND ORDER This case is an appeal by South Coast Spine and Rehab Center (Provider) from a decision of an independent review organization (IRO) on behalf of the Texas Workers= Compensation Commission (Commission) in a dispute regarding medical necessity for chiropractic treatment. The IRO found that Texas Workers= Compensation Solutions (Carrier) properly denied reimbursement […]
453-05-1722-m5
DECISION AND ORDER This case is a dispute over whether reimbursement is appropriate for a physical therapy program rendered to Claimant by Truman A. Davidson, D.C. (Provider), between August 14, 2002, and November 8, 2002. Provider sought reimbursement from Texas Mutual Insurance Company (Carrier) for the treatment rendered to Claimant, which Carrier denied as not […]