453-05-3173-m5
DECISION AND ORDER First Rio Valley Medical, P.A. (Petitioner), appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division (MRD) based on the decision of its designee, an independent review organization (IRO). The decision upheld Western Indemnity Insurance Company’s[1] (Carrier) denial of reimbursement for services provided a workers’ compensation claimant (Claimant) on […]
453-05-0163-m5
DECISION AND ORDER An injured worker, ___ (Petitioner), appealed the Texas Workers’ Compensation Commission’s Medical Review Division’s (MRD’s) dismissal of his request for reimbursement of a prescription medication. In this decision, the Administrative Law Judge (ALJ) finds that the Petitioner is due $7.49 in reimbursement. I. INTRODUCTION The notice of hearing was sent to Petitioner […]
453-05-8629-m5
DECISION AND ORDER In this case, Highpoint Pharmacy (Petitioner), challenges a decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission (Commission) in a dispute regarding the medical necessity of prescription medications. The IRO found that the insurer, Liberty Insurance Corporation (Respondent), properly denied reimbursement for medications that Petitioner provided […]
453-04-7156-m5-etal
DECISION AND ORDER J. C. Penney Corporation, Inc. (J. C. Penney) and Main Rehab and Diagnostic (Main Rehab) requested hearings on two decisions rendered by Independent Review Organizations (IRO) regarding services rendered to a workers’ compensation claimant. The requests were consolidated and a single hearing held. The Administrative Law Judge (ALJ) finds none of the […]
453-05-1115-m5
DECISION AND ORDER Petitioner Neuromuscular Institute of Texas (NMI) appealed the findings and decision of the Texas Workers’ Compensation Commission’s (Commission’s) designee, an independent review organization (IRO), which found that 24 sessions of physical therapy provided to a workers’ compensation claimant (Claimant) were not medically necessary health care. This decision agrees with the decision of […]
453-05-0989-m5
DECISION AND ORDER This case is an appeal by Mega Rehab from a decision by an Independent Review Organization (IRO) in a medical necessity dispute initiated before the Texas Workers’ Compensation Commission (Commission). Mega Rehab requested reimbursement for services provided to a Claimant from September 10, 2003, through October 23, 2003. The IRO determined that […]
453-05-1131-m5
DECISION AND ORDER Brett M. Downey (Provider) appealed the decision of the Texas Workers= Compensation Commission (Commission) designee, an Independent Review Organization (IRO), which denied his request for reimbursement for mechanical traction, manual therapy, therapeutic activities, neuromuscular reeducation, training in daily living activities, and office visits (collectively, requested services) from June 23, 2003, through September […]
453-04-6476-m5
DECISION AND ORDER Neuromuscular Institute of Texas, P.A. (Petitioner), appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division (MRD) to the findings of its designee, an independent review organization (IRO). The decision upheld Southwestern Bell Telephone Company’s (SBC) denial of reimbursement for services provided a workers’ compensation claimant (Claimant) on the […]
453-04-8656-m5
DECISION AND ORDER Southeast Health Services, Inc. (Provider), challenged the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission) denying reimbursement for office visits, joint mobilization, neuromuscular stimulation, and other physical medicine modalities provided to ___ (Claimant) from February 5, 2003, through May 12, 2003. Lumbermens Mutual Insurance Company (Carrier) […]
453-04-8177-m5
DECISION AND ORDER I. SUMMARY Marsha Miller, D.C., (Provider) appealed the decision of Envoy Medical Systems, LP, an independent review organization (IRO) certified by the Texas Department of Insurance, in Texas Workers’ Compensation Commission (TWCC) Medical Review Division (MRD) tracking number M5-04-2466-01, denying reimbursement for medical services provided to the Claimant. This decision orders that […]