453-05-3145-m5
DECISION AND ORDER First Rio Valley Medical, P.A. (Provider) appealed the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (the Commission) declining to order reimbursement of $1, 231.64 for office visits (CPT Code 99213), massage therapy (CPT Code 97124), therapeutic exercises (CPT Code 97110), and ultrasound therapy (CPT Code 97035) […]
453-05-3198-m5
DECISION AND ORDER I. DISCUSSION Christopher M. Loar, M.D. (Petitioner), requested a hearing to contest the September 30, 2004 Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through the Texas Medical Foundation, an Independent Review Organization (IRO), denying Petitioner reimbursement for a November 17, 2003 electrodiagnostic study[1] on the basis of medical […]
453-04-5358-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) challenged the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC or Commission) ordering it to reimburse Michael M. Stelzer, D. C. (Provider), for administering diagnostic needle electromyography (EMG) to L. S. (Claimant) on May 16, 2003. Carrier argued that the service […]
453-04-7289-m5
DECISION AND ORDER Pain & Recovery Clinic – North (Provider) appealed an Independent Review Organization (IRO) decision that determined 14 physical therapy sessions from March 24, 2003, through May 3, 2003, were not medically reasonable and necessary for a workers’ compensation claimant. The amount in dispute is $4,654. As reflected in the Findings of Fact […]
453-05-3064-m5
DECISION AND ORDER SCD Back & Joint Clinic (Petitioner) appealed the decision of the Texas Workers= Compensation Commission’s (Commission) Medical Review Division (MRD) based on the findings of its designee, an independent review organization (IRO). The IRO found that certain physical therapy passive modalities and supplies provided a workers= compensation claimant (Claimant) were not medically […]
453-05-0856-m5-etal
DECISION AND ORDER I. INTRODUCTION Liberty Mutual Insurance Company (Carrier) appealed two Independent Review Organization (IRO) decisions that determined work hardening therapy from June 23, 2003, to August 6, 2003, and an office visit on November 5, 2003, were medically reasonable and necessary for a workers’ compensation claimant. As reflected in the Findings of Fact […]
453-05-4166-m5
DECISION AND ORDER Texas Mutual Insurance Company (TMIC), a workers’ compensation carrier, requested a hearing on decisions of the Texas Workers’ Compensation Commission’s Medical Review Division (MRD) and an Independent Review Organization (IRO). Those decisions awarded some reimbursement to Joseph P. Viernow, D.C., for services Dr. Viernow had provided ___, a workers’ compensation claimant (the […]
453-04-6008-m5
DECISION AND ORDER The issue involved is whether Insurance Company of the State of Pennsylvania (Carrier) correctly denied payment of $893 billed by Trev Dixon, D.C. (Provider) for chiropractic services provided to an injured worker (Claimant) between May 14 and September 18, 2002. Carrier challenged the medical necessity of the treatment, but Provider contended that […]
453-04-7267-m5
DECISION AND ORDER I. DISCUSSION __Petitioner and Claimant, sought review of the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission). On May 24, 2004, MRD, acting through Independent Review, Inc., an independent review organization (IRO), issued a decision denying Claimant’s request for reimbursement of pharmaceutical expenses. The […]
453-05-0623-m5
DECISION AND ORDER Texas Mutual Insurance Company (Petitioner) requested a hearing to contest the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Envoy Medical Systems, LP, an Independent Review Organization (IRO), granting Work Ready Rehab L.T.D. (Respondent) reimbursement for the travel expenses of J.M. (Claimant). The Administrative Law Judge disagrees with […]