453-05-2003-m5
DECISION AND ORDER Cotton D. Merritt, D.C., (Petitioner) requested a hearing to contest the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Forte, an Independent Review Organization (IRO), denying Petitioner reimbursement for therapeutic procedures and exercises, kinetic exercises, joint mobilization, and myofacial release provided to Petitioner for the period March 24, […]
453-05-3728-m5
DECISION AND ORDER I. INTRODUCTION San Antonio Accident Injury Care (Provider) disputes a decision of an independent review organization (IRO) on behalf of the Texas Workers= Compensation Commission (TWCC) concerning medical services that it provided to ___ (Claimant). The IRO agreed with Texas Mutual Insurance Company (Carrier) that the Provider had failed to show that […]
453-05-3365-m5
DECISION AND ORDER West Houston Chiropractic (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 a work hardening program was medically unnecessary, denying reimbursement to West Houston Chiropractic for the program. Transport Insurance Company (Carrier), […]
453-05-1602-m5
DECISION AND ORDER Petitioner Southeast Health Services (SHS), a health care provider, requested a hearing on decisions of the Texas Workers’ Compensation Commission’s Medical Review Division (MRD) and an Independent Review Organization (IRO) that denied reimbursement for certain services provided ___, a workers’ compensation claimant (the Claimant). The Administrative Law Judge (ALJ) concludes that those […]
453-05-1608-m5
DECISION AND ORDER First Rio Valley Medical, P.A., (First Rio) appeals a decision by the Texas Workers’ Compensation Commission’s (TWCC) Medical Review Division (MRD) regarding the medical necessity of services provided to a workers’ compensation claimant (Claimant) during September and October 2003 for an injury that occurred on ___. Brownsville ISD (Respondent) denied reimbursement for […]
453-05-0855-m5
DECISION AND ORDER I. INTRODUCTION Cotton D. Merritt, D.C. (Petitioner) disputes a decision of an independent review organization (IRO) issued on behalf of the Texas Workers= Compensation Commission (TWCC)/Medical Review Division (MRD) in which American Home Assurance Company (Carrier) denied payment for various services provided by Petitioner to Claimant including one-on-one physical therapy, kinetic activities, […]
453-05-1647-m5
DECISION AND ORDER I. INTRODUCTION Liberty Mutual Fire Insurance Company (Carrier) challenges a decision of the Texas Workers= Compensation Commission’s (TWCC or Commission) Medical Review Division (MRD) regarding medical services that Joseph Priester Vernow, D.C. (Provider or Dr. Vernow) provided ___ (Claimant) from February 1, 2003, through December 15, 2003. MRD, relying on a determination […]
453-05-3209-m5
DECISION AND ORDER I. INTRODUCTION American Zurich Insurance Company (Carrier) challenges a decision of the Texas Workers= Compensation Commission’s (TWCC or Commission) Medical Review Division (MRD) regarding medical services that Pain & Recovery Clinic of North Houston and Nestor Martinez, D.C. (Provider or Dr. Martinez) provided _____ (Claimant) from October 20, 2003, through November 14, […]
453-05-2111-m5
DECISION AND ORDER Texas Mutual Insurance Co. (APetitioner) has challenged the decision of an independent review organization (AIRO) on behalf of the Texas Workers= Compensation Commission (ACommission) in a dispute regarding the medical necessity of services related to a course of physical therapy. The IRO found that Petitioner improperly denied reimbursement for services that Parker […]
453-05-0588-m5
DECISION AND ORDER This case is a dispute over whether Liberty Mutual Fire Insurance Company (Carrier) should reimburse VONO (Provider) for prescription medications Celebrex, Hydrocodone/APAP, and Cyclobenzaprine from May 9, 2003 through July 9, 2003. The medical necessity of the medications is the only issue to be resolved. The Administrative Law Judge (ALJ) concludes that […]