453-05-0977-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) appealed the decision of the Texas Workers= Compensation Commission’s (Commission=s) Medical Review Division (MRD), which found, based on a review by an independent review organization (IRO), that some of the contested therapeutic exercises and work hardening services provided by Rehab 2112 to Claimant ___ were medically necessary. […]
453-05-3159-m5
DECISION AND ORDER This case is an appeal by both Texas Mutual Insurance Company (Carrier) and Waco Ortho Rehab Associates, LLC, (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 the Carrier […]
453-05-0940-m5
DECISION AND ORDER Highpoint Pharmacy (Petitioner) appealed the findings and decision of the Texas Workers= Compensation Commission’s designee, an independent review organization (IRO), which found that prescriptions that Petitioner provided a workers= compensation claimant (Claimant) were not medically necessary healthcare. The IRO’s decision upheld a denial of reimbursement by the Liberty Insurance Company (Carrier). This […]
453-05-1114-m5
DECISION AND ORDER The issue involved is whether Metropolitan Transit Authority, Harris County[1] (Carrier) correctly denied payment of $ 517 billed by Medpro Clinics (Provider) for physical therapy provided to an injured worker (Claimant) between November 21 and December 1, 2003. Carrier challenged the medical necessity of the treatment, but Provider contended the physical therapy […]
453-05-3149-m5
DECISION AND ORDER Galveston County (Carrier) denied payment for all services[1] provided by Suhail al-Sahli, D.C., to an injured worker between March 7 and November 5, 2003, on the grounds that the treatment was not medically necessary. An Independent Review Organization (IRO), acting on behalf of the Medical Review Division (MRD) of the Texas Workers’ […]
453-05-4231-m5
DECISION AND ORDER Merritt Chiropractic, P.A. (Provider) seeks reimbursement of $4,554.54 from Texas Mutual Insurance Company (Carrier) for office visits, therapeutic activities, neuromuscular reeducation, manual therapy (myofascial release and joint mobilization), and gait training (collectively called medical services) provided to injured worker ___(Claimant) from August 25, 2003, through December 17, 2003 (disputed period). An independent […]
453-04-7291-m5
DECISION AND ORDER Texas Mutual Insurance Company (TMI) appeals a decision by the Texas Workers’ Compensation Commission’s (TWCC) Medical Review Division (MRD) regarding the medical necessity and documentation of chiropractic services provided to a workers’ compensation claimant by Respondent Candido F. Garcia, D.C. MRD referred the medical necessity issues to an independent review organization (IRO), […]
453-05-3148-m5
DOCKET NO. 453-05-3148.M5 TWCC MRD NO. M5-04-1590-01 BOYD CHIROPRACTIC CENTRE V. SERVICE LLOYDS INSURANCE COMPANY ‘ ‘ ‘ ‘ ‘ ‘ BEFORE THE STATE OFFICE OF ADMINISTRATIVE HEARINGS DECISION AND ORDER Boyd Chiropractic Centre (Provider) seeks reimbursement of $6,160 from Service Lloyds Insurance Company (Carrier) for office visits, therapeutic activities, neuromuscular re-education, myofascial release, joint […]
453-05-1113-m5
DECISION AND ORDER Highpoint Pharmacy (Provider) challenged the decision of the Medical Review Division (MRD) of the Texas Workers= Compensation Commission (TWCC or Commission) denying reimbursement to Provider for prescriptions it dispensed to ___ (Claimant) between May 14, 2003, and September 24, 2003. The Insurance Company of the State of Pennsylvania (Carrier) argued that the […]
453-05-0972-m5
DECISION AND ORDER This case is a dispute over whether reimbursement is appropriate for treatment rendered to Claimant by John Randolph, D.C. (Provider), between October 21, 2002, and June 27, 2003. Provider initially sought reimbursement from Texas Mutual Insurance Company (Carrier) in the amount of $23,706 for the treatment rendered to Claimant, which was denied […]