453-05-3061-m5-a
AMENDED DECISION AND ORDER Rehab 2112 and American Casualty Company (American Casualty) have challenged the decision of the Texas Workers= Compensation Commission’s (Commission=s) Medical Review Division (MRD), which found that work hardening provided to Claimant ___ was not medically necessary healthcare except for work hardening provided on July 16 and 18, 2003.The Administrative Law Judge […]
453-04-2686-m5
DECISION AND ORDER Petitioner ___challenges the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission). The MRD denied Petitioner’s request for reimbursement for certain prescription medicines based on lack of medical necessity. The Administrative Law Judge (ALJ) finds that the Petitioner failed to prove that the prescription medicines […]
453-05-3206-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) challenges the decision of the Independent Review Organization (IRO) granting reimbursement for physical therapy and office visits provided to injured worker H.A. (Claimant). After considering the evidence and arguments of the parties, the Administrative Law Judge (ALJ) concludes that Carrier has shown that the majority of services […]
453-05-0943-m5
DECISION AND ORDER Neuromuscular Institute of Texas (Provider) challenges an Independent Review Organization (IRO) decision denying reimbursement for physical therapy services provided following trigger point injections (TPIs). ACE USA (Carrier) denied reimbursement for the services as not medically necessary. The Administrative Law Judge (ALJ) concludes that some of the disputed services were shown to be […]
453-05-8923-m5
DECISION AND ORDER Liberty Mutual Insurance Company as carrier for Southwestern Bell Telephone Company (Carrier) denied reimbursementon the basis that the treatment of Claimant rendered by Michael P. McGarrah, D.C. (Provider) was not medically necessary. Provider appealed from the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (the Commission) denying […]
453-05-0519-m5
DECISION AND ORDER This is a dispute over reimbursement for services performed for an injury suffered by Claimant while in the course and scope of his employment. The Administrative Law Judge (ALJ) concludes that certain of the disputed services should be reimbursed for Carrier’s failure to issue timely Explanation of Benefits; and certain disputed services […]
453-05-0945-m5
DECISION AND ORDER The worker’s compensation claimant (Claimant) in this case sustained compensable injuries to her back and ankle when a wheel chair ran into her from behind on a ramp. At issue are approximately three months of therapeutic services provided by the petitioner, San Antonio Accident Injury Case (SAAIC). The carrier, San Antonio Independent […]
453-05-3185-m5
SOAH DOCKET NO. 453-05-3185.M5 K. B. FAIRCLOTH, D.C., § BEFORE THE STATE OFFICE Petitioner § § VS § OF § US SPECIALTY INSURANCE, § Respondent § ADMINISTRATIVE HEARINGS I. DECISION AND ORDER K. B. Faircloth, D.C. (‘Petitioner’), has challenged the Findings and Decision of the Texas Workers’ Compensation Commission’s Medical Review Division (‘MRD’) in a […]
453-05-4232-m5
DECISION AND ORDER Mega Rehab challenges the decision of the Texas Workers= Compensation Commission’s (Commission=s) Medical Review Division (MRD) denying reimbursement for one-on-one therapeutic exercises. The Administrative Law Judge (ALJ) concludes that Mega Rehab is not due additional reimbursement. I. BACKGROUND, PROCEDURAL HISTORY, NOTICE, AND JURISDICTION Claimant, an injured worker, was employed as a security […]
453-05-3063-m5
DECISION AND ORDER I. DISCUSSION Texas A & M University System (TAMU) requested a hearing to contest the November 8, 2004, Decision of the Texas Workers’ Compensation Commission (Commission) allowing SCD Back and Joint Clinic, Ltd. (SCD), reimbursement, on the basis of medical necessity, for analgesic balm,[1] therapeutic exercises,[2] muscle testing,[3] office visits,[4] joint mobilization,[5] […]